Document Detail

EQ-5D in patients with dementia: an investigation of inter-rater agreement.
MedLine Citation:
PMID:  11468496     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There are difficulties in obtaining health-related quality of life (HRQL) data from patients with dementia due to variation in their cognitive ability, degree of insight and capacity to make judgments. The use of proxies is one solution. OBJECTIVES: To examine the inter-rater agreement of patient and proxy completion of the EuroQol EQ-5D instrument (EQ-5D). RESEARCH DESIGN: The EQ-5D instrument was completed separately by patients, their caregivers and a physician. Assessment of inter-rater agreement involved comparison of self-completed (patient) and proxy-completed (caregiver and physician) responses for each dimension of EQ-5D, using a weighted kappa score. Three key hypotheses were tested. (1) Interrater agreement would be stronger between patient and caregiver than between patient and physician. (2) Interrater agreement would be stronger on the 'observable' and objective dimensions of EQ-5D. (3) Interrater agreement between patient and proxies would be stronger for patients with earlier dementia. SUBJECTS: The sample comprised 64 patients with a range of dementia severity. MEASURES: The EQ-5D health state classification system and visual analogue scale were used to assess HRQL. Global severity of dementia was determined using the Clinical Dementia Rating Scale. RESULTS: The principal finding of this study was that responses to EQ-5D questions were highly variable across the three raters such that none of the three hypotheses were strongly supported. CONCLUSIONS: The data provide some support for the use of EQ-5D when interviewer administered. However, there are serious concerns regarding the validity of patient self-rated HRQL data obtained in this study and uncertainty exists regarding who the appropriate proxy should be, as different groups of proxies provide different results. It was not clear whether caregivers or physicians represent better proxies. Further research should focus on the comparison of caregivers and physicians as proxies.
W Coucill; S Bryan; P Bentham; A Buckley; A Laight
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medical care     Volume:  39     ISSN:  0025-7079     ISO Abbreviation:  Med Care     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-07-24     Completed Date:  2001-09-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  760-71     Citation Subset:  IM    
Health Economics Facility, University of Birmingham, England, UK.
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MeSH Terms
Activities of Daily Living
Aged, 80 and over
Analysis of Variance
Dementia / diagnosis*,  psychology
Middle Aged
Observer Variation
Psychometrics / methods*
Quality of Life*
Reproducibility of Results
Self Care
Severity of Illness Index
Comment In:
Med Care. 2001 Aug;39(8):753-5   [PMID:  11468494 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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