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The EQ-5D-3L Questionnaire Demonstrates Moderate Ceiling Effects at One and Two Years After Total Hip Arthroplasty:
Yeon Joo Lee1, Nicholas David Clement2, Vipin Asopa1
1South West London Elective Orthopaedic Centre, Epsom Hospital, Epsom, Surrey, UK.
Background:
The objectives were to evaluate whether the EQ-5D-3L questionnaire demonstrated a ceiling effect after total hip arthroplasty (THA), identify which patients were more likely to reach the ceiling score, and determine whether this limited assessment of potential improvement, relative to baseline, in their outcomes.
Methods:
A cohort of 7,871 primary THAs was identified from an institutional arthroplasty database. Patient demographics, American Society of Anesthesiologists grade, socioeconomic status, Oxford Hip Score (OHS), and EQ-5D-3L were prospectively collected preoperatively and one and two years postoperatively. Regression analyses were performed to determine which preoperative factors were independently associated with achieving a ceiling score.
Results:
The median preoperative EQ-5D-3L was 0.516, improving significantly at one year to 0.850 (P < 0.001), with nonsignificant change at two years (median, 0.883; P = 0.075). A ceiling effect was observed in 47.5% (n = 2,961) at one year, increasing to 48.6% (n = 2,853) at two years. Women, younger age, lower socioeconomic deprivation, and higher preoperative OHS, EQ-5D, and EQ-VAS were independent predictors of achieving a ceiling EQ-5D. Receiver operating characteristic curve analyses indicated that a preoperative EQ-5D score (≥ 0.534) predicted postoperative ceiling scores at one and two years (area under the receiver operating characteristic curve, 65.6 and 64.1%, respectively; P < 0.001). Patients who reached the postoperative EQ-5D ceiling had significant improvements in OHS, EQ-5D, and EQ-VAS and were more likely to achieve minimal important change and a patient-acceptable symptom state compared with those below the ceiling.
Conclusions:
The EQ-5D showed moderate ceiling effects at one and two years following THA, with higher preoperative scores being associated with ceiling attainment. Patients who reached the ceiling experienced greater improvements from baseline and were more likely to achieve clinically meaningful outcomes.