EQ-5D-5L in Pulmonary Rehabilitation

Among the 542 patients that received pulmonary rehabilitation services, half of the patients (59.2%) were older adults and half (50.9%) were male (Table 1). The primary conditions for presenting to pulmonary rehabilitation were chronic obstructive pulmonary disease (65.5%) or other respiratory condition (28.0%). The approximate duration of intervention (based on EQ-5D-5L measurement) ranged from 28 to 184 days, with a mean (SD) duration of 47.0 days (23.5) and median duration of 31.0 days.

Table 1 Demographics by sample and service area

At intake, the proportion of patients reporting mild to extreme problems (levels 2-5) was 72.5% in mobility, 29.9% in self-care, 77.1% in usual activities, 70.5% in pain/discomfort, and 61.4% in anxiety/depression. The mean (SD) index score was 0.73 (0.17), the mean VAS score was 62.3 (19.4), and the mean total sum score was 10.2 (3.2) (Table 2).

Table 2 EQ-5D-5L dimensions, index, VAS, and total sum scores at intake and end of rehabilitation across the three programs compared to Alberta Norms

By the end of the rehabilitation intervention, there was an 1.3% decrease in the proportion of patients reporting no problems on all EQ-5D-5L dimensions, and the proportion of patients reporting problems in self-care and pain/discomfort increased slightly. Based on PCHC, 9.4% of patients had no change in their health status, 37.1% had an improvement, 23.4% had a deterioration, and 30.1% had a mixed change. By the end of the care intervention, there was an average increase of 0.02 (SD 0.12) in the index score (effect size = 0.1), an increase of 6.0 points (SD 18.3) in the VAS (effect size = 0.31), and a decrease of 0.45 (SD 2.35) in the total sum score (effect size = 0.13). All changes were of small magnitude, and those of the index and VAS scores did not reach MID thresholds.

The largest improvements were observed in usual activities followed by mobility. Less than half of patients improved based on the index (38.4%), VAS (45.8%), and total sum (47.4%) scores; health status either did not change or deteriorated in the other half (Fig. 1a).

Fig. 1

Change (%) in EQ-5D-5L dimensions, index, VAS, and total sum scores from intake until end of rehabilitation by program. a Pulmonary Rehabilitation. b Group-based Community Exercise. c Physiotherapy

EQ-5D-5L in Group-based Community Exercise

Among the 463 patients that participated in group-based community exercise services, half of the patients (56.6%) were older adults, and the majority (71.1%) were female (Table 1). The top three primary conditions for presenting to community exercise were chronic pain (22.9%), osteoarthritis or inflammatory arthritis (19.2%), and falls/balance (8.9%). The duration of intervention ranged from 2 to 275 days, with a mean (SD) duration of 103.7 days (51.4) and median duration of 91 days.

At intake, the proportion of patients reporting mild to extreme problems (levels 2-5) was 79.1% in mobility, 33.5% in self-care, 79.3% in usual activities, 89.9% in pain/discomfort, and 59.2% in anxiety/depression. The mean (SD) index score was 0.70 (0.18), the mean VAS score was 65.3 (18.2), and the mean total sum score was 10.8 (3.1) (Table 2).

By the end of rehabilitation intervention, there was a 4.3% increase in the proportion of patients reporting no problems on all EQ-5D-5L dimensions, and the proportion of patients reporting problems on all dimensions decreased. Based on PCHC, 11.0% of patients had no change in their health status, 50.3% had an improvement, 16.9% had a deterioration, and 21.8% had a mixed change. By the end of the intervention, there was an average increase of 0.06 (SD 0.13) in the EQ-5D-5L index score (effect size = 0.3), and an increase of 6.6 points (SD 18.7) in the VAS score (effect size = 0.4), and a decrease of 1.22 (2.39) in the EQ-5D-5L total sum score (effect size =0.4). These changes were of small to moderate magnitude, with only the index score reaching the MID threshold.

The largest improvements were observed in mobility followed by usual activities, and then pain/discomfort. About half of the patients improved based on the index (51.2%), VAS (43.8%), and total sum (58.5%) scores; health status either did not change or deteriorated in the other half of patients (Fig. 1b).

EQ-5D-5L in Physiotherapy

Among the 391 patients that received physiotherapy services, more than half of the patients (64.7%) were middle aged (45-65 years) and over half (60.6%) were female (Table 1). The top three primary conditions for presenting to physiotherapy were orthopaedic surgery (40.2%), musculoskeletal conditions (30.2%), and fracture (17.4%). The duration of intervention ranged from 28 to 397 days, with a mean (SD) duration of 67.3 days (46.0) and median duration of 61 days.

At intake, the proportion of patients reporting mild to extreme problems (levels 2-5) was 67.3% in mobility, 39.9% in self-care, 83.4% in usual activities, 96.2% in pain/discomfort, and 41.4% in anxiety/depression. The mean (SD) index score was 0.71 (0.17), the mean VAS score was 68.3 (18.9), and the mean total sum score was 10.6 (2.9) (Table 2).

By end of rehabilitation, there was a 11.5% increase in the proportion of patients reporting no problems on all EQ-5D-5L dimensions and the proportion of patients reporting problems on all dimensions decreased. Based on PCHC, 5.1% of patients had no change in their health status, 73.2% had an improvement, 5.4% had a deterioration, and 16.4% had a mixed change. By the end of rehabilitation, there was an average increase of 0.13 (SD 0.16) in the EQ-5D-5L index score (effect size = 0.8), an increase of 12.2 points (SD 18.4) in the VAS score (effect size = 0.7) and a decrease of 2.81 (2.79) in the total sum score (effect size =1.0). All changes were of moderate to large magnitude, and those of the index and VAS scores reached MID thresholds.

The largest improvements were observed in usual activities, followed by pain/discomfort and then mobility. Most patients improved based on the index (72.4%), VAS (54.9%), and total sum scores (80.6%) (Fig. 1c).

Rehabilitation patients compared to Alberta general population

In pulmonary rehabilitation and group-based community exercise service programs, self-reported health based on the EQ-5D-5L was much worse than that of the general Alberta population at intake, regardless of the age group (Table 2). Patients receiving these services reported more problems on all EQ-5D-5L dimensions and has lower index and VAS scores. Despite slight improvements by the end of the rehabilitation service, self-reported health remained much lower than that of the general Alberta population (overall and in relevant age groups). Similarly, patients receiving physiotherapy reported more problems on all EQ-5D-5L dimensions at intake and had lower index and VAS scores compared to the general Alberta population. However, physiotherapy patients had larger improvements than pulmonary rehabilitation and community exercise patients in all EQ-5D-5L dimensions, especially in anxiety/depression. Moreover, the average index and VAS scores of physiotherapy patients surpassed the overall and relevant age groups of the general Alberta population norms (Table 2).

Distribution of self-reported health by service program

In the pulmonary rehabilitation program, the distribution across the health status change categories (i.e., “deteriorated”, “no change”, “improved”) based on the VAS was statistically significant with age (Table 3). Of the patients aged 25-44, 68% experienced no change and only 10% improved. A much greater proportion of improvement (42-50%) was seen in the older age groups (p = 0.014). The anxiety/depression dimension at intake was also statistically significant with the health status change categories based on the index (p < 0.001) and total sum scores (p < 0.001). Of the pulmonary rehabilitation patients that reported mild-extreme problems (levels 2-5) on the anxiety/depression dimension at intake, 46 and 55% improved on the index score and total sum score, respectively. Comparatively, patients that reported no problems (level 1) on the anxiety/depression dimension at intake, 48% experienced no change in index scores and 38% experienced a deterioration in total sum score.

Table 3 Change (%) in EQ-5D-5L index, VAS, and total sum scores by age, gender, region, anxiety/depression at intake across programs

In group-based community exercise, the distribution across the total sum score change categories was statistically significant with region and anxiety/depression at intake (Table 3). Of those who lived in urban areas, 65% experienced an improvement on the total sum score, compared to 52% who lived in rural areas (p = 0.009). The anxiety/depression dimension at intake was also statistically significant with change in index (p = 0.002) and total sum scores (p = 0.022). Of the community exercise participants that reported mild-extreme problems on the anxiety/depression dimension at intake, 58 and 64% improved on the index score and total sum scores, respectively. Comparatively, participants that reported no problems on the anxiety/depression dimension at intake, 41 and 51% improved on the index and total sum scores, respectively.

In the physiotherapy program, only the anxiety/depression at intake was statistically significant with change in index (p < 0.001), VAS (p = 0.004), and total sum (p = 0.005) scores (Table 3). Of the physiotherapy patients that reported mild-extreme problems on the anxiety/depression dimension at intake, 83, 63, and 88% improved on the index, VAS, and total sum scores, respectively. Comparatively, participants that reported no problems on the anxiety/depression dimension at intake, 65, 49, and 75% improved on the index, VAS, and total sum scores, respectively (Table 3).