Send to

Choose Destination
Qual Life Res. 2019 Mar 18. doi: 10.1007/s11136-019-02156-2. [Epub ahead of print]

Health-related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension.

Author information

Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Division Mother and Child, Utrecht University Medical Center, Utrecht, The Netherlands.
Consumer Safety Institute, Amsterdam, The Netherlands.
Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.



The EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. However, the lack of a cognition dimension is generally felt as disadvantageous as many injuries involve cognitive effects. We aimed to assess the added value of a cognitive dimension in a cohort of injury patients.


We analyzed EQ-5D-3L extended with cognition (EQ-5D + C) dimension responses of 5346 adult injury patients. We studied dimension dependency, assessed the additional effect of the cognitive dimension on the EQ-VAS, and, using the EQ-VAS as a dependent variable, determined the impact of EQ-5D and EQ-5D + C attributes in multivariate regression analyses.


Extreme cognitive problems combined with no problems on other dimensions are uncommon, whereas severe problems on other dimensions frequently occur without cognitive problems. The EQ-VAS significantly decreased when cognitive problems emerged. Univariate regression analyses indicated that all EQ-5D + C dimensions were significantly associated with the EQ-VAS. Exploratory analyses showed that using any set of five of the six EQ-5D + C dimensions resulted in almost identical explained variance, and adding the remaining 6th dimension resulted in a similar additional impact.


The addition of the cognition dimension increased the explanatory power of the EQ-5D-3L. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions.


Cognition; EQ-5D; Health-related quality of life; Injury; Trauma


Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center