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This study examined whether adding cognition (CO) and social participation (SP) bolt-ons improves EQ-5D-5L\u2019s measurement properties in German healthcare workers (HCW) with SARS-CoV-2 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>N\u2009=\u20093335 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both bolt-ons showed acceptable distributional properties; adding CO modestly reduced overall ceiling effect, while adding SP resulted in negligible change (\u201811111\u2019\u2009=\u200918.8% vs. \u2018111111\u2019\n                      <jats:sub>CO<\/jats:sub>\n                      \u2009=\u200914.8% and \u2018111111\u2019\n                      <jats:sub>SP<\/jats:sub>\n                      \u2009=\u200917.8%). Construct validity was supported by expected correlation patterns, i.e. r\n                      <jats:sub>CO,PCS-Score<\/jats:sub>\n                      \u2009=\u20090.63, r\n                      <jats:sub>SP, WHODAS<\/jats:sub>\n                      \u2009=\u20090.71. 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\u00a0(11\/13, RE\u2009=\u20090.94\u20131.22), whereas this was observed in approximately half of group comparisons for SP (6\/13, RE\u2009=\u20090.89\u20131.18). In multivariate models, adding CO to the EQ-5D-5L resulted in a small to moderate increase in explained variance for PCS symptom severity (\u0394\u00a0adj.\u00a0R\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>CO<\/jats:sub>\n                      \u2009=\u20090.04\u20130.07), whereas adding SP had a negligible impact (\u0394\u00a0adj. R\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>SP<\/jats:sub>\n                      \u2009\u2264\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11136-026-04226-8","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T13:40:31Z","timestamp":1775050831000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychometric validation of a cognition and social participation bolt-on for the EQ-5D-5L in SARS-CoV-2 infected German healthcare workers"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-6992","authenticated-orcid":false,"given":"Ines","family":"Buchholz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"L\u00fcdtke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"H\u00e4rter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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