Agreement between Patient and Proxy Assessments of Quality of Life among Older Adults with Vascular Cognitive Impairment Using the EQ-5D-3L and ICECAP-O.
BACKGROUND
The assessment of quality of life is critical in ascertaining the benefit of interventions aimed to reduce morbidity among individuals with cognitive impairment. However, the assessment of quality of life is challenging in this population due to the uncertain validity of patient responses as cognitive function declines. Hence, we examined the level of agreement between patient and proxy assessments of health related quality of life (HRQoL) and wellbeing based on the domains that comprise each of these constructs.


METHODS
Analysis of baseline data from 71 community-dwelling older adults with mild Vascular Cognitive Impairment (VCI) who participated in a six-month proof-of-concept single-blinded randomized trial. Level of agreement between patient and caregiver ratings of HRQoL (EQ-5D-3L) and wellbeing (ICECAP-O) were compared using raw agreement (%), intraclass correlation coefficient (ICC) and weighted Cohen's kappa statistic.


RESULTS
Self-care (assessed via the EQ-5D-3L) demonstrated almost perfect raw agreement between the patient and caregiver ratings. Three domains (mobility, pain and anxiety) of the EQ-5D-3L demonstrated fair agreement between the patient and caregiver ratings. Two (attachment and control) of the five ICECAP-O domains demonstrated slight agreement. The ICC indicated good agreement for the EQ-5D-3L and poor agreement for the ICECAP-O.


CONCLUSIONS
There is better patient-proxy agreement for the EQ-5D-3L compared with the ICECAP-O among individuals with mild VCI. These findings imply that the ICECAP-O may have limited clinical, research and policy related utility among individuals with mild VCI.


BACKGROUND
ClinicalTrials.gov NCT01027858.
Centre for Clinical Epidemiology and Evaluation, University of British Columbia & Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada.|Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.
Jennifer C
JC
Davis
Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
Ging-Yuek
GY
Hsiung
Centre for Clinical Epidemiology and Evaluation, University of British Columbia & Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada.
Stirling
S
Bryan
Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
Claudia
C
Jacova
Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada.
Patrizio
P
Jacova
Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada.
Michelle
M
Munkacsy
Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada.
Winnie
W
Cheung
St Paul's Hospital, Providence Health Care Department of Medicine, Vancouver, Canada.
Philip
P
Lee
Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada.|Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.|Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.
Teresa
T
Liu-Ambrose
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000503:physiopathology*; D003072:Cognition Disorders / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D019727:Proxy / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires