Open Access Research article

Measuring health-related quality of life in chronic obstructive pulmonary disease: properties of the EQ-5D-5L and PROMIS-43 short form

Fang-Ju Lin1, A Simon Pickard19*, Jerry A Krishnan12, Min J Joo2, David H Au3, Shannon S Carson4, Suzanne Gillespie5, Ashley G Henderson4, Peter K Lindenauer67, Mary Ann McBurnie5, Richard A Mularski5, Edward T Naureckas8, William M Vollmer5, Todd A Lee1 and on behalf of the CONCERT Consortium

Author Affiliations

1 University of Illinois at Chicago, Chicago, IL, USA

2 University of Illinois Hospital & Health Sciences System, Chicago, IL, USA

3 VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA

4 University of North Carolina, Chapel Hill, NC, USA

5 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA

6 Baystate Medical Center, Springfield, MA, USA

7 Tufts University School of Medicine, Boston, MA, USA

8 University of Chicago, Chicago, IL, USA

9 Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St., M/C 886, Chicago, IL 60612, USA

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BMC Medical Research Methodology 2014, 14:78  doi:10.1186/1471-2288-14-78

Published: 16 June 2014



The Patient Reported Outcomes Measurement Information System 43-item short form (PROMIS-43) and the five-level EQ-5D (EQ-5D-5L) are recently developed measures of health-related quality of life (HRQL) that have potentially broad application in evaluating treatments and capturing burden of respiratory-related diseases. The aims of this study were: (1) to examine their psychometric properties in patients with chronic obstructive pulmonary disease (COPD), and (2) to identify dimensions of HRQL that differ and do not differ by lung function.


We conducted a multi-center, cross-sectional study (“COPD Outcomes-based Network for Clinical Effectiveness & Research Translation” [CONCERT]). We analyzed patients who met spirometric criteria for COPD, and completed EQ-5D-5L and PROMIS questionnaires. Disease severity was graded based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. Pulmonary function test, PROMIS-43, EQ-5D (index score and EQ-Visual Analog Scale [EQ-VAS]), six minute walk test (6MWT), and three dyspnea scales (mMRC, Borg, FACIT-Dyspnea) were administered. Validity and reliability of EQ-5D-5L and PROMIS-43 were examined, and differences in HRQL by GOLD grade were assessed.


Data from 670 patients with COPD were analyzed (mean age 68.5 years; 58% male). More severe COPD was associated with more problems with mobility, self-care and usual activities (all p-values <0.01) according to EQ-5D-5L. Related domains on EQ-5D-5L, PROMIS and clinical measures were moderately (r = 0.30-0.49) to strongly (r ≥ 0.50) correlated. A statistically significant trend of decreasing HRQL with more severe lung functions was observed for EQ-5D-5L index scores, EQ-VAS scores, and PROMIS physical function and social roles.


Results supported the validity of EQ-5D-5L and PROMIS-43 in COPD patients, and indicate that physical function and social activities decrease with level of lung function by GOLD grade, but not pain, mental health, sleep or fatigue as reported by patients.

COPD; EQ-5D-5L; PROMIS; Psychometric properties