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Convergent and Discriminant Validity of the Barthel Index and the EQ-5D-3L When Used on Older People in a Rehabilitation Setting

Author

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  • Billingsley Kaambwa

    (Health Economics, College of Medicine and Public Health, Bedford Park Campus, Flinders University, Sturt Road, Bedford Park 5042, Australia)

  • Norma B. Bulamu

    (Health Economics, College of Medicine and Public Health, Bedford Park Campus, Flinders University, Sturt Road, Bedford Park 5042, Australia)

  • Christine Mpundu-Kaambwa

    (Health and Social Care Economics Group, College of Nursing and Health Sciences, Bedford Park Campus, Flinders University, Sturt Road, Bedford Park 5042, Australia)

  • Raymond Oppong

    (Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK)

Abstract

This study compares the empirical performance of a commonly used functional-status measure, the Barthel Index (BI), to that of a widely used generic preference-based instrument, the EuroQoL-5-Dimensions 3 Level (EQ-5D-3L), in older people. Data from older people receiving rehabilitation services were used to test the validity of the BI and EQ-5D-3L. Convergent validity was investigated using Spearman’s correlation, exploratory factor analysis (EFA), scatter plots, Krippendorff’s alpha and modified Bland-Altman plots. Discriminant validity was examined using Kruskal Wallis tests, ceiling effects and EFA. A total of 1690 participants were included in the analysis. The BI total and EQ-5D-3L utility scores showed moderate correlation (r = 0.51; Krippendorff’s alpha = 0.52). Kendall’s Tau-B correlations between BI items and EQ-5D-3L dimensions measuring the same construct were weak to moderate (0.05 ≤ absolute r ≤ 0.54). In the EFA, some BI items cross-loaded onto the same factors as EQ-5D-3L dimensions, suggesting that the instruments were interrelated. The BI, however, focuses more on physical functioning, while the EQ-5D-3L measures broader wellbeing concepts. Both instruments showed good discriminant validity and would therefore be equally valuable for measuring subgroup differences. Researchers should consider using the BI in rehabilitation to capture more physical functioning-specific constructs not measured by the EQ-5D-3L.

Suggested Citation

  • Billingsley Kaambwa & Norma B. Bulamu & Christine Mpundu-Kaambwa & Raymond Oppong, 2021. "Convergent and Discriminant Validity of the Barthel Index and the EQ-5D-3L When Used on Older People in a Rehabilitation Setting," IJERPH, MDPI, vol. 18(19), pages 1-16, September.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:19:p:10314-:d:647204
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    References listed on IDEAS

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    1. Coast, Joanna & Flynn, Terry N. & Natarajan, Lucy & Sproston, Kerry & Lewis, Jane & Louviere, Jordan J. & Peters, Tim J., 2008. "Valuing the ICECAP capability index for older people," Social Science & Medicine, Elsevier, vol. 67(5), pages 874-882, September.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    3. Billingsley Kaambwa & Julie Ratcliffe, 2018. "Predicting EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L) Utilities from Older People’s Quality of Life Brief Questionnaire (OPQoL-Brief) Scores," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 11(1), pages 39-54, February.
    4. Joanna Coast & Richard Smith & Paula Lorgelly, 2008. "Should the capability approach be applied in Health Economics?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 667-670, June.
    5. Makai, Peter & Brouwer, Werner B.F. & Koopmanschap, Marc A. & Stolk, Elly A. & Nieboer, Anna P., 2014. "Quality of life instruments for economic evaluations in health and social care for older people: A systematic review," Social Science & Medicine, Elsevier, vol. 102(C), pages 83-93.
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