A comparison of the validity of self-report measures amongst people with acquired brain injury: A preliminary study of the usefulness of EuroQol-5D

Abstract

EuroQol-5D has been used as a means of assessing health service effectiveness. This study examines its validity regarding people with acquired neurological disorders. Fifty-two participants with such disorders were studied. Each person completed the EuroQol-5D and the Dysexecutive Questionnaire (DEX-S). In addition, ratings were made by therapists regarding them using a modified version of the EuroQol-5D, DEX-O, and Barthel ADL (Activities of Daily Living) Index. A subsample was followed up and the procedure repeated (mean 10 months later). Results using the DEX support previous research that demonstrated that people with acquired neurological disorders tend to underestimate their difficulties. In contrast, lack of differences between EuroQol-5D ratings made by patients and staff was attributed to a weakness in the scale in that it primarily measures physical difficulties. EuroQol-5D ratings made by staff did not change on repeat assessment, despite several months exposure to neuro-rehabilitation. However, ratings made by patients suggested significant improvement. Although only a small number were followed up, repeat DEX ratings suggested both groups perceived significant improvement regarding cognitive, emotional, and behavioural sequela of brain injury; however, patients persisted in underestimating their extent. It was concluded that failure to capture the rich diversity of difficulties associated with acquired neurological disorders, too narrow a range of ratings available, and reliance on self-report, conspired to undermine the validity of EuroQol-5D. Consequently, its usefulness with this population should be questioned.