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In the widely applied HRQL instrument, the EQ-5D, this aspect is not included directly, for its assumed lack of additional information. We investigated the validity of this assumption by determining the gain\u2014if any\u2014of an additional fatigue item to the EQ-5D-5L in a general population sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Dutch general population sample (including diseased people) completed a web-based survey including the EQ-5D-5L and the Rivermead Post-Concussion\u00a0Symptoms Questionnaire (RPQ). The RPQ fatigue item was used to create the EQ-5D-5L\u2009+\u2009Fatigue. We head-to-head compared the psychometric performance contrasting the EQ-5D-5L and EQ-5D-5L\u2009+\u2009Fatigue: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, domain dependency, and explanatory power. Results were compared between subgroups with and without\u2009\u2265\u20091 chronic health condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study population consisted of 3027 persons of whom 52% had a chronic health condition. The mean EQ-5D-5L utility score was 0.83 and 48% experienced some degree of fatigue. Adding the fatigue item to the EQ-5D-5L decreased the ceiling effect, increased absolute informativity (H\u02b9\u2009=\u20096.44 vs. H\u02b9\u2009=\u20094.90) and relative informativity (J\u02b9\u2009=\u20090.46 vs. J\u02b9\u2009=\u20090.42). The extra fatigue item slightly increased convergent validity (Spearman\u2019s rank correlation coefficient\u2009=\u2009\u2212\u20090.61 vs. \u2212\u20090.62). Domain dependency analysis showed that all EQ-5D-5L domains are dominant over the fatigue item. Explanatory power of the EQ-5D-5L\u2009+\u2009Fatigue was higher compared to the EQ-5D-5L (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.42 vs. 0.39). The gain is substantially larger in the subgroup with chronic health conditions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adding a fatigue item to the EQ-5D-5L improved all psychometric performance criteria of the enriched instrument in the general population. Effects are substantially larger in the subgroup with chronic health conditions, indicating that adding a fatigue item to the EQ-5D-5L is especially relevant in evaluating the HRQL of diseased people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41687-021-00406-x","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T06:03:34Z","timestamp":1641276214000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Adding a fatigue item to the EQ-5D-5L improves its psychometric performance in the general population"],"prefix":"10.1186","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9571-576X","authenticated-orcid":false,"given":"Inge","family":"Spronk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4331-3141","authenticated-orcid":false,"given":"Suzanne","family":"Polinder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8364-1086","authenticated-orcid":false,"given":"Gouke J.","family":"Bonsel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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