Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania

Saulius Taroza; Julius Burkauskas; Narseta Mickuviene; Nijole Kazukauskiene; Aurelija Podlipskyte

doi:10.3389/fpsyg.2023.1284859

Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania

Front Psychol. 2023 Dec 6:14:1284859. doi: 10.3389/fpsyg.2023.1284859. eCollection 2023.

Authors

Saulius Taroza¹, Julius Burkauskas¹, Narseta Mickuviene¹, Nijole Kazukauskiene¹, Aurelija Podlipskyte¹

Affiliation

¹ Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.

Abstract

Background: Experiencing stroke is associated with deterioration in health-related quality of life (HRQL). One of the generic tools used for HRQL assessment is the EuroQol instrument of five dimensions and five levels (EQ-5D-5L), which has not yet been validated in Lithuania. This study aimed to evaluate validity, reliability, and factor structure of the EQ-5D-5L instrument in a sample of Lithuanian individuals at the end of the first week after experiencing ischemic stroke (IS).

Methods: The study had a cross-sectional design, including 134 individuals [61.9% men and 38.1% women; median (IQR) age was 66 years (59-73) years, in the final analysis]. Alongside the EQ-5D-5L, psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Assessment-7 (GAD-7); neurological impairment with the National Institutes of Health Stroke Scale (NIHSS); and functional independence with the Barthel index (BI). Confirmatory factor analysis (CFA) was performed for validation of the factor structure.

Results: The internal consistency of the EQ-5D-5L instrument was 0.81. A significant ceiling effect (17.2%) of the descriptive part of the EQ-5D-5L was detected. The convergent validity of the EQ-5D-5L descriptive system was confirmed, with significant correlations with the other scales used, except for the visual analog scale. The two-factor ("physical" and "emotional") model was confirmed by CFA, with acceptable fit [root mean square error of approximation (RMSEA) = 0.045, RMSEA 90% CI = 0.000-0.145; comparative fit indices (CFI) = 0.996; non-normal fit index (NFI) = 0.983; Tucker-Lewis Index (TLI) = 0.936; χ²/df = 1.27)].

Conclusion: This study provides information on the psychometric properties of the EQ-5D-5L instrument in Lithuanian individuals, showing that the EQ-5D-5L descriptive system is a reliable and valid tool for HRQL assessment. The Lithuanian version of the descriptive part of the EQ-5D-5L instrument is best expressed as a two-factor model, estimating the physical and emotional dimensions of HRQL in individuals who have experienced IS.

Keywords: Lithuanian people; anxiety; cross-sectional studies; depression; ischemic stroke; psychometrics; quality of life.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by a Grant (No. S-MIP-23-103) from the Research Council of Lithuania.