Children living in urban-poor communities are particularly vulnerable to poor health-related quality of life (HRQoL) because socioeconomic disadvantage, food insecurity, constrained food environments, and limited access to health-promoting resources may affect both nutritional status and psychosocial well-being. Although nutrition knowledge, attitude, and practice (KAP) are known to influence children’s health behaviours, the behavioural pathways through which these factors affect HRQoL remain insufficiently understood. This study examined the interrelationships between nutrition KAP, lifestyle-related behaviours, body composition, and HRQoL among children from urban-poor flats using serial mediation analysis. A cross-sectional study was conducted using cluster sampling to recruit eligible participants from ten urban-poor flats in Kuala Lumpur, Malaysia. Participants completed a sociodemographic questionnaire, nutrition knowledge, attitude, and practice (KAP) questionnaire, Eating Behaviours Questionnaire (EBQ), Physical Activity Questionnaire for Older Children (PAQ-C), and Pediatric Quality of Life Inventory™ (PedsQL™) 4.0. The body composition of the children was also measured using InBody 270s bioelectrical impedance analysis. Serial mediation analysis was conducted through path analysis to evaluate the inter-relationships between variables. A total of 408 children (mean age = 9.7 years) were recruited. Nutrition attitude significantly mediated the relationship between nutrition knowledge and nutrition practice (b = 0.034, 95
Quality of life(QOL) has increasingly gained attention in the medical field. Although specific QOL measurement scales for brain cancer, such as FACT-Br and QLQ-BN20, are available, culturally specific scales reflecting Chinese cultural characteristics are lacking. This study aims to develop and validate the brain cancer scale within the system of QOL instruments for cancer patients QLICP-BN (V2.0), which is suitable for Chinese patients with brain cancer. Using the programmed decision method and instrument development theory, including nominal group and focus group discussions, we developed the QLICP-BN (V2.0) using a modular approach and Chinese cultural characteristics. We used classical test theory (CTT) and generalizability theory (GT) to screen items and evaluate the scale’s reliability, validity, and responsiveness. Specifically, a generalizability study (G-study) in GT identified error sources, and a decision study (D-study) optimized the measurement design accordingly. QLICP-BN (V2.0) was developed with 5 domains: physical, psychological, social, common symptoms and side effects, and the specific module, and a total of 47 items can be considered the optimal number. Regarding reliability, the Cronbach’s α coefficient for the QLICP-BN (V2.0) is 0.919, the test-retest correlation coefficient (r) is 0.805, and the ICC in all domains and on the total scale was higher than 0.80. G-study findings indicate that domain score variation primarily stems from the “participant-item” interaction, and D-study demonstrates that the G-coefficient and ɸ index of the QLICP-BN (V2.0) were 0.926 and 0.899, respectively; the relative and absolute error values were 0.015 and 0.021, respectively, reaching the ideal level. With respect to validity, the scale demonstrates good content validity; Confirmatory factor analysis indicates that the scale dimensions fit well, indicating satisfactory construct validity; And criterion-related validity is acceptable. With respect to responsiveness, the pre-treatment total scale score was 57.321 ± 10.625, while the post-treatment total scale score was 64.125 ± 8.699, with a statistically significant difference (t = -17.789, P < 0.001), and an effect size SRM = 1.057 representing excellent responsiveness. QLICP-BN (V2.0) has good validity, reliability, and responsiveness for the clinical assessment of QOL in Chinese patients with brain cancer.
This study evaluated psychometric properties of the experimental 9-item EQ Health and Wellbeing (EQ-HWB-9 2022 version) separately among patients with gastric, pancreatic, and colorectal cancer. Patients recruited from a tertiary hospital in Shanghai, China completed the experimental EQ-HWB-9 (2022 version), EQ-5D-5L, SF-6Dv2, FACT-G (from which FACT-8D was extracted), and EORTC QLQ-C30 (from which QLU-C10D was extracted) at two routine visits. Clinical data were extracted from medical records. Convergent validity, known-groups validity, and responsiveness were assessed. Analysis included 164 gastric, 135 pancreatic, and 203 colorectal cancer patients. The experimental EQ-HWB-9 (2022 version) index score showed moderate to strong correlations with those of EQ-5D-5L, SF-6Dv2, FACT-8D, QLU-C10D and single-item global health and quality-of-life scales (rs: 0.46–0.80). It demonstrated known-groups validity for ECOG status (Cohen’s d: 0.94–1.49), cancer stage (0.29–0.49), and financial burden (0.38–0.49) across three cancer types, although it failed to discriminate cancer stage in colorectal cancer. Among anchor-defined improved patients, SRM values showed higher responsiveness for pancreatic cancer than for gastric and colorectal cancer. Among anchor-defined deteriorated patients, SRM values were similar across three cancers. This is the first study to evaluate the psychometric properties of experimental EQ-HWB-9 (2022 version) by individual cancer type. The instrument demonstrated generally satisfactory construct validity and preliminary evidence of responsiveness in three gastrointestinal cancers, although differences in psychometric performance across cancer types warrant further investigation. Not applicable. This study evaluated construct validity and responsiveness of the experimental EQ-HWB-9 (2022 version) separately among patients with gastric, pancreatic, and colorectal cancer. The experimental EQ-HWB-9 (2022 version) demonstrated generally satisfactory construct validity and preliminary evidence of responsiveness, with psychometric performance varying by cancer type. This study suggests possible heterogeneity in the psychometric performance of the experimental EQ-HWB-9 (2022 version) across gastrointestinal cancer types.
Patients with coronary heart disease (CHD) commonly experience depressive and anxiety symptoms, poor sleep quality, and low health-related quality of life (HRQoL). However, inter-relationships between such mental health problems at a symptom level and their associations with HRQoL among patients with CHD remain unclear. This study compared the prevalence and network structure of psychiatric symptoms between participants with and without CHD and examined the associations between these symptoms and HRQoL. We conducted a cross-sectional nationwide survey and applied propensity score matching (PSM) to balance demographic characteristics between the CHD and non-CHD groups. The study used standardized instruments for depressive and anxiety symptoms, sleep quality, and HRQoL, and employed network analysis to identify central and bridge symptoms. The analyses included a total of 1,027 patients with CHD and 2,048 matched controls. The CHD group showed significantly higher prevalence of depressive symptoms (71.9
This study aimed to evaluate and compare the psychometric performance of the experimental EuroQol Toddler and Infant Populations version 2.0 (EQ-TIPS) and the Paediatric Quality of Life Inventory (PedsQL) in Chinese infants and toddlers with omphalocele or Tetralogy of Fallot (TOF) following surgical repair. Parents of children with omphalocele or ToF who attended the Children’s Hospital, Zhejiang University School of Medicine in China from 2018 onwards were contacted and recruited in September and October 2023. In this cross-sectional study, EQ-TIPS-3L experimental version EV2.0 and PedsQL were administered online, in a fixed order, to parents of children aged 1 month to 4 years via proxy report. Response distribution, known-group and convergent validity were assessed for both instruments by clinical sample and by child age (1–12 months, 13–24 months, 2–4 years). EQ-TIPS level sum scores (LSS), EQ VAS and PedsQL total scores were used as outcomes. Participants included 115 parents of children with omphalocele (mean age = 1.73 years) and 123 parents of children with TOF (mean age = 1.73 years) cases. Over 95
Workplace age discrimination (WAD) is an emerging psychosocial stressor that may undermine health-related quality of life (HRQoL), including those working in educational settings. The present study examined associations between WAD and HRQoL and tested potential mediators among Taiwanese schoolteachers. In a cross-sectional online survey, 611 teachers (75
The World Health Organization Five Well-Being Index (WHO-5) is commonly applied to assess subjective well-being. However, evidence on its ordinal measurement properties among young adolescents, especially in low- and middle-income countries, is scant. In particular, there is a lack of studies that have comprehensively evaluated key Mokken model assumptions, including scalability, monotonicity and invariant item ordering. Evaluating these properties is important as they support the ordinal interpretation of WHO-5 scores and clarify whether the items form an invariant hierarchy. Baseline data from the FLOURISH project, a multi-country study evaluating a family-focused prevention program in Moldova and North Macedonia, were used. The sample comprised 653 adolescents aged 10–14 years. The ordinal scaling properties of the WHO-5 were examined using Mokken Scale Analysis, a non-parametric item response theory approach. Specifically, overall and item-level scalability were evaluated using Loevinger’s H coefficients. Single monotonicity was evaluated by examining local decreases in item step response functions, while invariant item ordering was assessed by examining pairwise intersections between manifest item response functions. The accuracy of the estimated ordering was evaluated using the HT coefficient. Analyses were also conducted separately by gender and country. The WHO-5 demonstrated strong overall scalability (h = 0.53, 95
Men receiving pharmacologic treatment for benign prostatic hyperplasia (BPH) may experience reduced quality of life (QoL) owing to persistent overactive bladder (OAB) symptoms. Vibegron, a β3-adrenergic receptor agonist, was approved for OAB symptoms based on the COURAGE trial. We present exploratory patient-reported outcomes from COURAGE. Eligible men were ≥ 45 years old with OAB symptoms receiving BPH treatment (α-blocker ± 5α-reductase inhibitor). Patients were randomly assigned 1:1 to receive vibegron 75 mg or placebo for 24 weeks. Patients completed the OAB questionnaire (OAB-q) and Patient Global Impression (PGI) scales at baseline and weeks 12 and 24. Changes from baseline in OAB-q subscores and PGI scales were assessed. An anchor-based approach was used to determine the distribution of change from baseline in COURAGE trial endpoints (micturitions, urgency, nocturia, and urge urinary incontinence [UUI] episodes) by category of change on the PGI change (PGI-C) scale. Of 1105 patients (vibegron, n = 551; placebo, n = 554); 1080 (vibegron, n = 538; placebo, n = 542) had evaluable data and were included in the analysis. Baseline mean OAB-q and PGI scores were similar between treatment groups. Patients receiving vibegron had statistically significantly greater improvements vs. placebo from baseline to week 12 (P < 0.05) for all OAB-q subscale scores and improvements remained statistically significant at week 24 (P < 0.05), except for social interaction. Patients receiving vibegron had improvements from baseline on all PGI endpoints at weeks 12 and 24. A higher percentage of patients receiving vibegron (81.9
To explore the cross-sectional and prospective associations of perceived family support with diabetes-specific quality of life (QoL) in type 2 diabetes mellitus (T2DM) adults, and whether the baseline indirect association through depressive symptoms differed across personality profiles. In this 12-month longitudinal study, 737 T2DM patients from community health service centers in Beijing were included. They completed the follow-up and provided valid data. Family support, depressive symptoms, personality traits and diabetes-specific QoL were assessed at baseline. Family support and QoL were reassessed at 12 months. Hierarchical regression examined the prospective association of baseline family support with 12-month QoL. PROCESS Model 7 investigated baseline conditional indirect associations via depressive symptoms across personality profiles. At baseline, greater family support showed a direct association with poorer QoL after adjustment for depressive symptoms (B = 0.116, p < 0.001). In the Introverted-Stable (IS) profile, greater family support was related to fewer depressive symptoms (B = -0.023, p = 0.019), with a significant conditional indirect association with better QoL (effect = －0.046, 95
Infertility and its treatment have negative impacts on a couple’s marital relationship, sexual life, psychological state and interpersonal relationships, causing personal distress. Identifying socio-contextual factors and experience of infertile couples can help establish a foundation for tailored interventions that support patient-centered health care. The aim of this study was to develop a de novo HRQoL instrument for male and female infertility patients in China, and evaluate its psychometric properties based on classical test theory (CTT) and item response theory (IRT). The psychometric properties validation study consisted of two phases. First, we conducted a cross-sectional study in five reproductive medicine centers. Offline, one-on-one, and face-to-face surveys were conducted with patients experiencing infertility at each reproductive medicine center. Regarding the test-retest reliability assessment, the online Infertility-QoL was administered 2 weeks after the baseline to a random group of patients with stable disease condition. In the second phase, in order to measure the responsiveness, the patients were invited to complete an online Infertility-QoL after two months. Infertility patients were recruited from a national multicenter survey in China. Participants completed a series of HRQoL instruments, including the Infertility-QoL, FertiQoL, and WHO-5. The survey also involved the socio-demographic information and clinical characteristics of the respondents. CTT and IRT were used to assess psychometric performance of the Infertility-QoL. A total of 1343 infertility patients were invited to participate in the study, a valid sample of 1172 (87.3
Behavioral decision-making plays a critical role in the willingness of high-risk populations to participate in cancer screening. However, there is currently a lack of valid and reliable tools for evaluating the level of cancer screening behavioral decision-making in these populations. This study aimed to develop an instrument for assessing the level of cancer screening behavioral decision-making in high-risk populations. Scale development was conducted in six phases: (1) a literature review and establishment of the Protective Action Decision Model as the theoretical framework; (2) individual interviews to generate an initial item pool; (3) two rounds of Delphi consultation and a pilot study to refine the items; (4) item reduction; (5) and (6) psychometric evaluation using both Classical Test Theory (CTT) and Item Response Theory (IRT). A total of 766 high-risk individuals were recruited through purposive sampling. The data were analyzed using SPSS 26.0, Mplus 6.1, and R 4.4.3. The CTT analysis included assessments of construct validity, content validity, known-group validity, and reliability. IRT analysis was used to examine item discrimination, difficulty parameters, item information, item characteristic curves, marginal reliability, and differential item functioning. The final scale comprises 24 items across five dimensions, explaining 62.61
Previous longitudinal evidence has suggested that patients aged > 75 years may be associated with a poorer Health Utility Index Mark 3 (HUI-3) trajectory. We compared the longitudinal health utility scores (HUS) of older (>75 years) versus younger patients with head and neck cancers across various clinical subgroups and identified factors associated with decline in quality of life. The study prospectively collected clinical information and follow-up data from head and neck cancer patients. The HUI-3 scale was used to assess changes in health-related quality of life at baseline, post-surgery, mid-radiation therapy, and at 3, 6, and 12 months. A linear mixed model was employed to evaluate the changes in HUS and age categories over time. We included 859 patients with head and neck cancer, of whom 647 were included in the longitudinal analytic cohort. In descriptive analyses, patients aged > 75 years showed less complete recovery in mean HUS after early treatment-related decline compared with younger patients. In the primary mixed-effects model, younger age groups had more positive average HUS slopes than patients aged > 75 years. However, these age-related differences were attenuated and were no longer statistically supported after adjustment for clinical stage, Eastern Cooperative Oncology Group (ECOG) performance status, and treatment modality. Subgroup findings were exploratory and were not consistently supported across all model-based comparisons. Patients aged > 75 years may be at risk for slower or incomplete post-treatment recovery in HUI-3–derived health utility. These findings should be interpreted cautiously given potential selection bias, missing data, and attenuation after covariate adjustment. Larger studies with detailed geriatric and domain-specific functional measures are needed to confirm these patterns.
Multimorbidity is common among rural middle-aged and older adults and is associated with poorer health-related quality of life (HRQoL). Evidence on HRQoL in this population remains limited in China, particularly from nationally representative data. This study examined factors associated with HRQoL among rural Chinese middle-aged and older adults with multimorbidity. We conducted a secondary analysis of the 2020 China Health and Retirement Longitudinal Study. The analysis included 1,411 rural participants aged 45 years or older with multimorbidity. HRQoL was measured using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3 L). Least absolute shrinkage and selection operator regression was used for variable selection, and Tobit regression was used to estimate associations between selected variables and EQ-5D-3 L utility score. In the Tobit regression model, male was positively associated with EQ-5D-3 L utility score (β = 0.089, 95
Metabolic-dysfunction associated steatotic liver disease (MASLD) is a progressive chronic liver condition characterised by substantial inter-patient variation in disease severity, with the probability of progressing to hepatic fibrosis, cirrhosis or hepatocellular carcinoma. The prevalence of MASLD is increasing rapidly and may have a significant impact on health-related quality of life (HRQoL). A novel non-preference-based Patient-Reported Outcome Measure (PROM) called NASH-CHECK has been developed to assess outcomes in metabolic dysfunction-associated steatohepatitis (MASH), previously called non-alcoholic steatohepatitis (NASH). Preference-based outcome measures are needed to generate quality adjusted life years (QALYs) for economic evaluation. The aim of this study was to generate mapping algorithms to predict EQ-5D-5L utility scores from the NASH-CHECK in a MASLD population. A large dataset comprising 1,971 MASLD cases from seven European countries (France, Italy, Portugal, Netherlands, Spain, Sweden and UK) was used to generate the mapping algorithms. Regression results from a number of popular candidate models were compared against each other in terms of statistical and visual fit, including more conventional models (OLS, Tobit, Two-Part) and the more recently developed Adjusted Limited Dependent Variable Mixture Model (ALDVMM). Mapping was conducted separately for each of the seven countries. The ALDVMM with higher numbers of components provided the best visual fit across all samples, especially at the low end (representing very poor health states and worse-than-death health states) and high end (representing fairly good health states and full health) of the EQ-5D-5L distributions. The ALDVMM also produced predicted estimates which had the best statistical fit (in terms of mean absolute error, root mean square error and information criteria where applicable) for samples with relatively large number of observations. Using an ALDVMM with higher numbers of components provides estimates across the whole distribution for the prediction of EQ-5D-5L as a function of NASH-CHECK scores for people with MASLD in several European countries. This enables QALYs to be indirectly calculated in this patient population when a preference-based measure such as the EQ-5D-5L has not been collected.
Patient-reported outcome measures often assume that translated response options represent comparable gradations of difficulty, frequency, or severity across countries, yet this is rarely tested directly. This study investigated how general population adults in the United States, United Kingdom, and Germany interpreted EQ-HWB-9 response options across three response scale types: difficulty, frequency, and severity. A cross-sectional online survey was conducted between September 2025 and February 2026 using quota sampling on age and gender in all countries and race/ethnicity in the US (US n = 348, UK n = 312, Germany n = 293). Participants completed a slider positioning task for each of nine EQ-HWB-9 dimensions and a ranking task for each of three response scale types. In the slider task, intermediate response options were positioned on a 0–100 scale anchored by the two extreme options; in the ranking task, randomized response options were ordered. Discrimination between adjacent response levels was assessed using Cohen’s d (small ≤ 0.49, medium 0.50–0.79, large ≥ 0.80). Cross-country differences in slider means were tested using one-way ANOVA. Ordinal structure was preserved across all three countries: slider means increased monotonically across response levels in every domain, and the majority of respondents in each country correctly ordered the five response levels (73–77
Abstract Background Depression and anxiety are important adolescent mental health concerns and may be linked to modifiable movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep. As mental health outcomes depend not only on time spent in specific behaviors but also on the trade-offs between them, this study examined the associations of reallocating 30 min between these behaviors with adolescent psychological symptoms. Methods This cross-sectional study included 7,767 adolescents from Henan Province, Central China, in 2023. Daily PA, SB, and sleep duration were self-reported. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured with the 7-item Generalized Anxiety Disorder Scale. Isotemporal substitution models estimated the associations of 30-minute reallocations with depressive and anxiety symptoms. Interaction tests and subgroup analyses were conducted according to sleep status. Results Replacing 30 min of SB with sleep or PA was associated with lower levels of depression (sleep, B = -0.47, 95%CI = -0.53~-0.41; PA, B = -0.12, 95%CI = -0.16~-0.08) and anxiety (sleep, B = -0.31, 95%CI = -0.36~-0.25; PA, B = -0.07, 95%CI = -0.10~-0.04). Reallocating PA to sleep also related to reduced depressive symptoms (B = -0.35, 95%CI = -0.42~-0.28) and anxiety symptoms (B = -0.24, 95%CI = -0.30~-0.18). Among adolescents with insufficient sleep, the associations were stronger when reallocating SB to sleep (for depression: B = -0.52, 95%CI = -0.64~-0.39; for anxiety: B = -0.40, 95%CI = -0.50~-0.28) or PA to sleep (for depression: B = -0.39, 95%CI = -0.50~-0.25; for anxiety: B = -0.32, 95%CI = -0.41~-0.19). Among those with sufficient sleep, reallocating SB to PA or sleep remained associated with lower depressive symptoms, but no significant association was observed for anxiety. Conclusions Reallocating time toward sleep and PA was associated with reduced depressive and anxiety symptoms, particularly among adolescents with insufficient sleep. Accounting for sleep status may help advance understanding of the associations between movement behavior reallocations and adolescent mental health.
To explore the effect of stress on the quality of life (QoL) of patients with Type 2 Diabetes Mellitus (T2DM) in the Middle East and North Africa (MENA) region and compare with other regions. T2DM prevalence has increased in the MENA region. Besides its physiological implications, T2DM affects patients’ QoL by influencing psychosocial and health-related stressors. This systematic review explores how stress can affect the QoL of T2DM patients, providing MENA region-specific insights to improve patient outcomes. This review also compares QoL across high- and low-income countries within and beyond the MENA region. Our review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024612361. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide our review. A robust search strategy was employed in 4 databases: PubMed, Scopus, Cochrane, and Embase. We included observational studies published between January 1, 2004, and July 20, 2025, that explored the association between stress and the QoL of T2DM patients. The quality of the included studies was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale. Data extraction and analysis were conducted in accordance with the PRISMA guidelines. The search identified 402 publications, of which 28 observational studies met the inclusion criteria. Five main factors were identified as stressors contributing to T2DM patients’ QoL: gender differences, psychological factors, socioeconomic factors, lifestyle factors, and health-related factors. Emotional distress, female gender, diabetes-related complications, elevated Hemoglobin A1c (HbA1c) levels, and poor lifestyle were all negatively associated with QoL. A positive correlation was drawn between education, health literacy, and QoL. Higher-income countries have a better T2DM QoL. Stress factors significantly affect QoL in T2DM patients, with psychological, socioeconomic, gender differences, lifestyle, and health-related factors playing an important role. Future studies should explore direct causal relationships between stress factors and QoL in T2DM, particularly emphasizing the female population.
The EuroQol Health and Wellbeing 9 (EQ-HWB-9) is an experimental generic instrument designed for use in settings, populations and contexts where measuring wellbeing alongside health is relevant to decision making, such as in social care or in assessing impacts on carers. This study aims to assess the content validity of the EQ-HWB-9 self-complete and proxy versions in dyads of older adult social care users and their carers in Hungary, and to qualitatively compare the ‘experimental modified’ (2024) version with the ‘experimental’ (2022) version. In 2025, one-on-one, semi-structured interviews incorporating item-level probing and a card-sorting exercise were conducted with 15 dyads of older adult social care users and their carers in Hungary, using a convenience recruitment strategy. The self-complete version of EQ-HWB-9 was used for care recipients, while the proxy version (proxy-proxy perspective) was used for carers. We followed a standardised topic guide, focusing on three elements of content validity: comprehensibility, relevance and comprehensiveness. The interviews were analysed using framework analysis. EQ-HWB-9 was positively viewed by both older adult care recipients and carers, with all items considered comprehensible and relevant by most respondents in the social care context. Carers’ interpretations of the proxy version aligned with those of care recipients. Three respondents considered the examples ‘working, shopping, housework’ in the day-to-day activities item not relevant. Ten respondents mentioned seven missing concepts, most commonly social relationships, community life and intellectual life. In terms of preferences for modifications, there was support for starting with day-to-day activities, using ‘difficulty’ rather than ‘trouble’ for the ‘concentrating/thinking clearly’ item, and ‘moderate’ over ‘some’ for the difficulty response scale. However, the experimental version’s wording was preferred for the mobility and control items. Overall, 28 of 30 respondents correctly ranked the cards in the card-sorting exercise for the modified frequency scale. This study confirmed the content validity of the experimental modified EQ-HWB-9 self-complete and proxy versions in Hungarian social care user older adult-carer dyads and provided systematic evidence on the proposed modifications to inform the finalisation of the instrument.
Patient-reported outcomes (PROs) in peripheral artery disease (PAD) provide valuable insights when assessing meaningful health status improvement after intervention. This study implemented routine PRO workflows in a large academic PAD practice to assess feasibility expressed as completion rates and describe patient PRO profiles. Routine health status assessments using the Peripheral Artery Questionnaire (PAQ), VascuQoL-6, and EQ-5D were implemented (March 2021-July 2022) as a quality initiative for all patients with PAD at Yale’s outpatient interventional cardiology vascular clinic. Higher health status scores indicated better health status and quality of life. Scores were compared by initial visit type (new/pre-procedural vs. routine/post-procedural), and demographics (sex, race, and age < 65 vs. ≥65 years) using standardized differences (d), and minimally clinically important difference (MCID) benchmarks. Of 933 surveys distributed, 704 (75.5
This study aimed to compare the performance of the Chinese versions of the ICECAP-O and EQ-5D-5L in patients with Kashin-Beck disease (KBD), and to explore the relationship between the two instruments. Data were collected from 222 elderly Chinese patients with KBD using both the ICECAP-O and the EQ-5D-5L. To compare the two instruments and examine their relationship, we assessed floor/ceiling effects, known-groups validity (non-parametric tests with a priori hypotheses), polychoric correlations, and regression analyses. The Chinese version of the ICECAP-O was free of floor or ceiling effects and demonstrated known-groups validity consistent with a priori hypotheses. In contrast, the EQ-5D-5L exhibited ceiling effects in the Mobility, Self-care, Usual activities, and Anxiety/Depression dimensions, and no floor effects. The median (Q1, Q3) index scores were 0.6465 (0.5558, 0.7609) for the ICECAP-O and 0.6050 (0.3755, 0.7690) for the EQ-5D-5L. A moderate-to-strong positive polychoric correlation was found between the two instrument scores (ρ = 0.656, p < 0.001). Regression analysis showed that both instrument scores differed across subgroups defined by sociodemographic characteristics and clinical conditions. This study provides the first application of the ICECAP-O in patients with KBD in China. The instrument captures capability well-being dimensions beyond the EQ-5D-5L. These findings support the complementary use of both instruments for a more comprehensive assessment of patient well-being and to inform economic evaluations.
