ArticleHealth and quality of life outcomes2026
Comparative exploration of EQ-5D-5L bolt-on variants for fatigue, sleep, and vision in a general population sample.
Article in Health and quality of life outcomes, 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
objectiveFatigue, sleep, and vision are among the most commonly used EQ-5D-5 L bolt-ons, with multiple alternative wordings. This study aimed to evaluate and compare the psychometric performance of the following bolt-on variants: (1) fatigue (FA) vs. tiredness (TI); (2) vision (VI) vs. VI with reference to vision aids (VI-A); and (3) sleep (SL) vs. sleep with examples in the dimension title (SL-E).
methodsA representative sample of 1,262 adults in Hong Kong completed an online survey including the EQ-5D-5 L and bolt-ons. The following psychometric properties were assessed: ceiling/floor, informativity (Shannon's indices), convergent validity (correlations with conceptually related items of PROMIS-29 + 2), agreement (Kendall's tau), explanatory power (regression on EQ VAS and PROMIS-29 + 2 Level Sum Scores), and known-group validity (effect sizes).
resultsBolt-ons reduced EQ-5D-5 L's ceiling from 35% to 20-24% and improved relative informativity from 0.33 to 0.35-0.36. FA, TI, SL and SL-E demonstrated moderate-to-strong convergent validity (r = 0.55-0.67) with PROMIS-29 + 2 items. All bolt-ons with the exception of VI-A enhanced explanatory power for both EQ VAS and PROMIS-29 + 2. Agreements between TI and FA (0.71), SL and SL-E (0.74), and VI and VI-A (0.78) were strong. For each of the three bolt-on pairs, differences in reducing the EQ-5D-5 L's ceiling, relative informativity and convergent validity were generally small. In known-group comparisons, FA and SL-E outperformed their counterparts, whereas the difference between VI and VI-A was minimal.
conclusionAll six bolt-on items showed good validity in a general population sample, with minimal differences between items belonging to the same bolt-on pair. These findings inform item development for the experimental EQ-5D Bolt-on Toolbox.
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