ArticleQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2026
Psychometric validation of a cognition and social participation bolt-on for the EQ-5D-5L in SARS-CoV-2 infected German healthcare workers.
Article in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeCOVID-19 can result in long-term impairments, including cognitive difficulties and restrictions in social participation, which may not be fully captured by EQ-5D-5L. This study examined whether adding cognition (CO) and social participation (SP) bolt-ons improves EQ-5D-5L’s measurement properties in German healthcare workers (HCW) with SARS-CoV-2 infection.
methodsN = 3335 HCW with self-reported occupational COVID-19 completed an online survey including EQ-5D-5L, two candidate bolt-ons (CO, SP), and validated self-report instruments (e.g., Post-COVID Syndrome PCS-Score, PHQ-4, PTSD screening, SSD-12, WAI, WHODAS). Psychometric analyses covered distributional characteristics (response pattern, missing values, ceiling), construct (convergent and divergent) validity, known-groups validity, and explanatory power.
resultsBoth bolt-ons showed acceptable distributional properties; adding CO modestly reduced overall ceiling effect, while adding SP resulted in negligible change (‘11111’ = 18.8% vs. ‘111111’CO = 14.8% and ‘111111’SP = 17.8%). Construct validity was supported by expected correlation patterns, i.e. rCO,PCS-Score = 0.63, rSP, WHODAS = 0.71. Known-groups validity improved with the inclusion of bolt-ons, as reflected by higher or comparable relative efficiency (RE) compared with EQ-5D-5L in most group comparisons for CO (11/13, RE = 0.94–1.22), whereas this was observed in approximately half of group comparisons for SP (6/13, RE = 0.89–1.18). In multivariate models, adding CO to the EQ-5D-5L resulted in a small to moderate increase in explained variance for PCS symptom severity (Δ adj. R2CO = 0.04–0.07), whereas adding SP had a negligible impact (Δ adj. R2SP ≤ 0.01).
conclusionWhile CO improved ceiling, construct, and known-groups validity of the EQ-5D-5L in SARS-CoV-2 infected HCW, the added value of SP appeared limited.
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