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Purpose <p>The EQ-5D has been criticized for lacking dimensions for breathing and cognition. In acute COVID-19 and Long COVID, breathing problems and cognitive complaints are common. This study evaluated the inclusion of EQ-5D-5L (bolt-on) items that assess these dimensions.</p> Methods <p>In a follow-up of community-based non-hospitalized patients with COVID-19 in 2020 (n = 450), we used respiratory and cognitive bolt-on items alongside other questionnaires about 30&#xa0;months later (n = 220). We assessed data quality and construct validity for the bolt-ons, including comparison with concurrently used instruments’ domain and item scores. Bolt-on scores were correlated with pulmonary function tests and tablet-based cognitive tests about 1&#xa0;year earlier. Finally, we assessed the contribution of the bolt-ons to variability of the EQ VAS.</p> Results <p>Most patients had none or slight problems with breathing and cognition. The breathing problems bolt-on had an 8% lower ceiling effect, but otherwise a similar response distribution to the mMRC. Cognition bolt-on and four DSQ-SF item scores relating to frequency and severity were similar, except 2–13% higher ceiling effects for the former. The breathing bolt-on had a rank correlation of 0.54 with mMRC scores and higher correlations with Dyspnoea-12 scale scores. EQ-5D-5L dimensions explained 54% of variation in EQ VAS scores; the breathing bolt-on contributed a further 2%, but the cognition bolt-on contributed very little.</p> Conclusion <p>The results support the validity of the two bolt-ons in follow-up of non-hospitalized patients after COVID-19. Adding items of respiratory and cognitive symptoms may enhance the EQ-5D's appropriateness in respiratory and cognitive research and clinical practice.</p>

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Validity of EQ-5D-5L breathing and cognition bolt-ons in non-hospitalized patients after COVID-19

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月9日

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  • Knut Stavem,
  • Andrew M. Garratt

摘要

Purpose

The EQ-5D has been criticized for lacking dimensions for breathing and cognition. In acute COVID-19 and Long COVID, breathing problems and cognitive complaints are common. This study evaluated the inclusion of EQ-5D-5L (bolt-on) items that assess these dimensions.

Methods

In a follow-up of community-based non-hospitalized patients with COVID-19 in 2020 (n = 450), we used respiratory and cognitive bolt-on items alongside other questionnaires about 30 months later (n = 220). We assessed data quality and construct validity for the bolt-ons, including comparison with concurrently used instruments’ domain and item scores. Bolt-on scores were correlated with pulmonary function tests and tablet-based cognitive tests about 1 year earlier. Finally, we assessed the contribution of the bolt-ons to variability of the EQ VAS.

Results

Most patients had none or slight problems with breathing and cognition. The breathing problems bolt-on had an 8% lower ceiling effect, but otherwise a similar response distribution to the mMRC. Cognition bolt-on and four DSQ-SF item scores relating to frequency and severity were similar, except 2–13% higher ceiling effects for the former. The breathing bolt-on had a rank correlation of 0.54 with mMRC scores and higher correlations with Dyspnoea-12 scale scores. EQ-5D-5L dimensions explained 54% of variation in EQ VAS scores; the breathing bolt-on contributed a further 2%, but the cognition bolt-on contributed very little.

Conclusion

The results support the validity of the two bolt-ons in follow-up of non-hospitalized patients after COVID-19. Adding items of respiratory and cognitive symptoms may enhance the EQ-5D's appropriateness in respiratory and cognitive research and clinical practice.