Evaluation of the EQ-5D-3L and 5L Versions in Low Back Pain Patients

Evaluation of the EQ-5D-3L and 5L Versions in Low Back Pain Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Evaluation of the EQ-5D-3L and 5L Versions in Low Back Pain Patients AM Garratt, Håvard Furunes, Christian Hellum, Tore Solberg, Jens Ivar Brox, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-152708/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: The EuroQol EQ-5D is the most widely researched and applied patient-reported outcome measure worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods: LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results: At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices also showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. In a multivariate regression analysis, ODI, Pain-VAS and HSCL-25 scores explained 13% more variation in EQ-5D-5L scores compared to 3L scores. Conclusion: The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial Registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677. Health Economics & Outcomes Research EQ-5D-3L EQ-5D-5L low back pain patient reported outcome measures PROMs quality of life validity psychometrics Full Text Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the latest manuscript can be downloaded and accessed as a PDF. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major Revision 15 Mar, 2021 Review # 3 received at journal 06 Mar, 2021 Review # 2 received at journal 06 Mar, 2021 Reviewer # 3 agreed at journal 14 Feb, 2021 Review # 1 received at journal 14 Feb, 2021 Reviewer # 2 agreed at journal 10 Feb, 2021 Reviewers invited by journal 26 Jan, 2021 Reviewer # 1 agreed at journal 26 Jan, 2021 Editor assigned by journal 19 Jan, 2021 Submission checks completed at journal 19 Jan, 2021 Editor invited by journal 19 Jan, 2021 First submitted to journal 18 Jan, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-152708","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":8757320,"identity":"960e1daa-a6e9-4ad5-96bb-51203261dac1","order_by":0,"name":"AM Garratt","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYHACA2SODb8BM0laDiSkSW4gVcthyQ2E1PPPbt724WMbg13/7LMPP3/8cV7CnJ2B7cEHPFok7hwrnjmzjSF5xrl0Y4kDCbclLJsZ2A1n4LPmRo4xM+82hmSGM2wMIC11BocZ2KR58OiQB2n5C9Qif4aN+ceBhHMSBLUYgLQwbmOwMzjDxga05QBhLYY30ooZe/9JJBgCtVicSUsGamFsk8TnF7kbyZsZfpyxsZcDOuxGhY2dhMH5w8ck8IUYFEgkNiA4jA24lKEAe6JUjYJRMApGwcgEAMJsSWbW1CRDAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-1000-4780","institution":"Norwegian Institute of Public Health","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"AM","middleName":"","lastName":"Garratt","suffix":""},{"id":8757321,"identity":"97eb081f-6a74-49d0-afa4-57ca9ba176a5","order_by":1,"name":"Håvard Furunes","email":"","orcid":"","institution":"Innlandet Hospital Trust: Sykehuset Innlandet HF","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Håvard","middleName":"","lastName":"Furunes","suffix":""},{"id":8757322,"identity":"7a86f714-b313-444e-b336-e7c073c73090","order_by":2,"name":"Christian Hellum","email":"","orcid":"","institution":"Oslo University Hospital: Oslo Universitetssykehus","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Hellum","suffix":""},{"id":8757323,"identity":"a6e465af-a00b-4c45-b0b1-2347abf21b82","order_by":3,"name":"Tore Solberg","email":"","orcid":"","institution":"University Hospital of Northern Norway","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tore","middleName":"","lastName":"Solberg","suffix":""},{"id":8757324,"identity":"8a2ea071-eb5e-4426-817c-9bd07ee2b328","order_by":4,"name":"Jens Ivar Brox","email":"","orcid":"","institution":"Oslo University Hospital: Oslo Universitetssykehus","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jens","middleName":"Ivar","lastName":"Brox","suffix":""},{"id":8757325,"identity":"c8c6314e-4940-45f8-91c0-2b603eb90f27","order_by":5,"name":"Kjersti Storheim","email":"","orcid":"","institution":"Oslo University Hospital: Oslo Universitetssykehus","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kjersti","middleName":"","lastName":"Storheim","suffix":""},{"id":8757326,"identity":"0c1f7ff5-cc20-4176-a269-1caf45e11bd9","order_by":6,"name":"Lars Gunnar Johnsen","email":"","orcid":"","institution":"Norwegian University of Science and Technology: Norges teknisk-naturvitenskapelige universitet","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lars","middleName":"Gunnar","lastName":"Johnsen","suffix":""}],"badges":[],"createdAt":"2021-01-21 19:57:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-152708/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-152708/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13652908,"identity":"e1ed91b2-fea6-4096-998b-60bda3e4b95b","added_by":"auto","created_at":"2021-09-17 09:51:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":133008,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-152708/v1/394f6106-6c42-45f1-b5fa-ac79b5156433.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eEvaluation of the EQ-5D-3L and 5L Versions in Low Back Pain Patients\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. 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The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices also showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. In a multivariate regression analysis, ODI, Pain-VAS and HSCL-25 scores explained 13% more variation in EQ-5D-5L scores compared to 3L scores. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial Registration:\u003c/strong\u003e retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.\u003c/p\u003e","manuscriptTitle":"Evaluation of the EQ-5D-3L and 5L Versions in Low Back Pain Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-26 00:15:41","doi":"10.21203/rs.3.rs-152708/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revision","date":"2021-03-16T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-03-07T00:00:00+00:00","index":3,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"editorInvitedReview","content":"","date":"2021-03-07T00:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2021-02-15T00:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-02-15T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2021-02-11T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-27T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-01-27T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-20T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-19T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-19T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2021-01-19T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-and-quality-of-life-outcomes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hqlo","sideBox":"Learn more about [Health and Quality of Life Outcomes](http://hqlo.biomedcentral.com)","snPcode":"12955","submissionUrl":"https://submission.nature.com/new-submission/12955/3","title":"Health and Quality of Life Outcomes","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3db34f19-0b1b-40b2-9efc-b0fff96d2f2b","owner":[],"postedDate":"January 26th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":2049245,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2021-05-19T22:28:10+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-26 00:15:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-152708","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-152708","identity":"rs-152708","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}