title: Estimating EQ-5D values from the Neck Disability Index and numeric rating scales for neck and arm pain.
abstract: OBJECTIVE
  The Neck Disability Index (NDI) and numeric rating scales (0 to 10) for neck pain and arm pain are widely used cervical spine disease-specific measures. Recent studies have shown that there is a strong relationship between the SF-6D and the NDI such that using a simple linear regression allows for the estimation of an SF-6D value from the NDI alone. Due to ease of administration and scoring, the EQ-5D is increasingly being used as a measure of utility in the clinical setting. The purpose of this study is to determine if the EQ-5D values can be estimated from commonly available cervical spine disease-specific health-related quality of life measures, much like the SF-6D.
  
  
  METHODS
  The EQ-5D, NDI, neck pain score, and arm pain score were prospectively collected in 3732 patients who presented to the authors' clinic with degenerative cervical spine disorders. Correlation coefficients for paired observations from multiple time points between the NDI, neck pain and arm pain scores, and EQ-5D were determined. Regression models were built to estimate the EQ-5D values from the NDI, neck pain, and arm pain scores.
  
  
  RESULTS
  The mean age of the 3732 patients was 53.3 ± 12.2 years, and 43% were male. Correlations between the EQ-5D and the NDI, neck pain score, and arm pain score were statistically significant (p < 0.0001), with correlation coefficients of -0.77, -0.62, and -0.50, respectively. The regression equation 0.98947 + (-0.00705 × NDI) + (-0.00875 × arm pain score) + (-0.00877 × neck pain score) to predict EQ-5D had an R-square of 0.62 and a root mean square error (RMSE) of 0.146. The model using NDI alone had an R-square of 0.59 and a RMSE of 0.150. The model using the individual NDI items had an R-square of 0.46 and an RMSE of 0.172. The correlation coefficient between the observed and estimated EQ-5D scores was 0.79. There was no statistically significant difference between the actual EQ-5D score (0.603 ± 0.235) and the estimated EQ-5D score (0.603 ± 0.185) using the NDI, neck pain score, and arm pain score regression model. However, rounding off the coefficients to fewer than 5 decimal places produced less accurate results.
  
  
  CONCLUSIONS
  The regression model estimating the EQ-5D from the NDI, neck pain score, and arm pain score accounted for 60% of the variability of the EQ-5D with a relatively large RMSE. This regression model may not be sufficient to accurately or reliably estimate actual EQ-5D values.
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Bratcher
authors.forename: Nandita
authors.initials: N
authors.lastname: Das
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Nienhuis
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
mesh_terms: D001132:Arm / Q000503:physiopathology*; D002574:Cervical Vertebrae; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology*; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: EQ-5D; EQ-5D-3L = EQ-5D 3 level; EQ-5D-5L = EQ-5D 5 level; NDI = Neck Disability Index; Neck Disability Index; QALY = quality-adjusted life year; RMSE = root mean square error; VAS = visual analog scale; cervical; cost-utility analysis; outcome measurement; utilities