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Original Investigation
November 23, 2016

Assessment of the EuroQol 5-Dimension Questionnaire for Detection of Clinically Significant Global Health-Related Quality-of-Life Improvement Following Functional Septorhinoplasty

Author Affiliations
  • 1Massachusetts Eye and Ear Infirmary, Boston
  • 2Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
  • 3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
JAMA Facial Plast Surg. Published online November 23, 2016. doi:10.1001/jamafacial.2016.1410
Key Points

Question  Can the EuroQol 5-Dimension (EQ5D) questionnaire detect meaningful change following functional septorhinoplasty for nasal obstruction?

Findings  In this cohort study, there were significant reductions in EQ5D visual analog scale (VAS) scores and in patients reporting problems in usual activity and pain/discomfort health domains. Baseline EQ5D VAS and Nasal Obstruction Symptom Evaluation (NOSE) scores were moderately correlated; patients reporting problems in usual activity and pain/discomfort had significantly higher NOSE scores.

Meaning  The EQ5D, a tool that can be used to calculate health utility values, was able to detect clinically significant global health improvement following functional septorhinoplasty for nasal obstruction.

Abstract

Importance  Nasal airway obstruction is a common presenting complaint among patients in otolaryngology practices, and its treatment necessitates critical outcomes evaluation and cost-utility analysis.

Objective  To evaluate the utility and applicability of the EuroQol 5-Dimension (EQ5D) global health-related quality-of-life (HRQoL) questionnaire for the assessment of clinical outcomes in functional septorhinoplasty.

Design, Setting, and Participants  Prospective cohort study at a university-based tertiary medical center of patients undergoing functional septorhinoplasty for treatment of nasal obstruction.

Interventions  Patient demographic characteristics, operative intervention, and preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) and EQ5D scores were collected and analyzed between November 2013 and June 2016.

Main Outcomes and Measures  Comparison of preoperative and postoperative EQ5D and NOSE scores at 2 and 6 or more months following surgery (long-term follow-up).

Results  A total of 135 patients (56.3% male; mean [SD] age, 36.8 [14.8] years) completed EQ5D and NOSE surveys preoperatively and postoperatively, with mean (SD) follow-up of 5.82 (4.1) months. Of these, 117 completed the 2-month survey and 64 completed their last survey at 6 or more months. Baseline NOSE and EQ5D visual analog scale (VAS) scores were moderately correlated (r = −0.37, P < .001) as were changes in NOSE and EQ5D VAS scores at long-term follow-up (r = −0.33, P = .007). Mean baseline NOSE score of 64.3 (95% CI, 60.5-68.2) decreased to 24.8 (95% CI, 18.8-30.9) at long-term follow-up (P < .001). The frequency of patients reporting problems in the EQ5D domains of pain/discomfort and usual activity decreased by more than half in the long-term follow-up group (30 [47%] vs 14 [22%] and 11 [17%] vs 4 [6%]; P = .002 and .02, respectively). The minimal clinically important difference of the EQ5D VAS score was calculated at 9.5. The EQ5D VAS scores had statistically and clinically significant improvement at long-term follow-up in patients with NOSE score improvements of 30 to 60 points (EQ5D VAS increased from mean [SD] of 72.3 [20] to 85.9 [10]; P < .001) and 65 to 100 points (EQ5D VAS increased from mean [SD] of 66.2 [25] to 82.0 [13]; P = .01).

Conclusions and Relevance  The EQ5D, a global HRQoL instrument, was able to detect clinically significant improvement following functional septorhinoplasty for nasal obstruction. Nasal valve correction improved not only disease-specific quality of life but also global HRQoL. The ability to calculate health utility values from the EQ5D and its low response burden make it an attractive tool for septorhinoplasty outcomes research.

Level of Evidence  4.

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