Using EQ-5D for Proxy Assessment of Health-Related Quality of Life in Residential Care Facilities: A Systematic Review of Feasibility and Psychometric Properties

Ling Jie Cheng; Lidia Engel; Le Ann Chen; Sonia Zhi Yi Soh; Gerald Choon-Huat Koh; Nan Luo

doi:10.1016/j.jamda.2023.10.020

Using EQ-5D for Proxy Assessment of Health-Related Quality of Life in Residential Care Facilities: A Systematic Review of Feasibility and Psychometric Properties

J Am Med Dir Assoc. 2023 Dec 1:104870. doi: 10.1016/j.jamda.2023.10.020. Online ahead of print.

Authors

Ling Jie Cheng¹, Lidia Engel², Le Ann Chen¹, Sonia Zhi Yi Soh¹, Gerald Choon-Huat Koh³, Nan Luo⁴

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Dean's Office and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, Singapore.
⁴ Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Electronic address: ephln@nus.edu.sg.

PMID: 38043585
DOI: 10.1016/j.jamda.2023.10.020

Abstract

Objectives: The accurate assessment of Health-Related Quality of Life (HRQoL) in residents of residential care facilities (RCF) necessitates the use of proxy-reported instruments that possess robust psychometric properties. Generally, these instruments are modified versions of self-reported tools, with adjustments made to pronouns and instructions to better suit the respondent. Among such tools, the EQ-5D has emerged as a prominent instrument for evaluating HRQoL within RCF settings. This review aimed to synthesize evidence on psychometric properties of the proxy version of EQ-5D.

Design: Systematic review and meta-analysis.

Setting and participants: Residents in RCF.

Methods: An extensive search was conducted across 8 databases, covering articles from inception to May 29, 2023. We included a total of 20 articles reporting data that can be used to evaluate psychometric properties of this instrument in RCF. The quality appraisal employed the COSMIN Risk of Bias checklist, and data synthesis followed COSMIN methodology.

Results: Most of the included studies were conducted in Europe, with 75% using nursing staff as proxies. Missing data rates were 5% for EQ-5D and 26% for EQ VAS. Evidence of moderate certainty on construct validity of the EQ-5D index was inconsistent, although the EQ VAS showed sufficient construct validity supported by high certainty. EQ-5D index responsiveness evidence was limited, characterized by low certainty and inconsistency. Proxy-resident agreement ranged from poor to moderate, and improved with repeated administration for the "mobility" and "usual activities" dimensions. The lowest agreement was observed when staff served as proxies or the proxy-proxy perspective was adopted.

Conclusions and implications: This review offers an overview of the psychometric properties of EQ-5D as a proxy HRQoL measure in RCF. The suboptimal evidence on psychometric properties of EQ-5D indicated the need for more validation studies and cautious use of the instrument in RCF.

Keywords: EQ VAS; EQ-5D; Psychometric properties; construct validity; meta-analysis; proxy-resident agreement; responsiveness; systematic review.

Publication types

Review