title: Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.
abstract: To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke.
  
  
  
  The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported.
  
  
  
  Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %).
  
  
  
  The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan, Taiwan.
authors.forename: Poyu
authors.initials: P
authors.lastname: Chen
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Keh-Chung
authors.initials: KC
authors.lastname: Lin
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan, Taiwan.
authors.forename: Rong-Jiuan
authors.initials: RJ
authors.lastname: Liing
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw.|Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ku-Chou
authors.initials: KC
authors.lastname: Chang
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071081:Minimal Clinically Important Difference; D010147:Pain Measurement / Q000379:methods; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000523:psychology / Q000628:therapy; D000071939:Stroke Rehabilitation / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: EQ-5D-5L; MCID; Quality of life; Rehabilitation; Stroke; Validity