Title: Mobility and Quality of Life: Improving methods of economic evaluation of assistive technology for adults and children with impaired mobility
Funder: Health and Care Research Wales (Welsh Government)

Abstract: In the UK over 11 million people live with an impairment: 45% of older people, 6% of children and 16% of working age adults are classified as disabled (Office for Disability Issues, 2014). In Wales alone nearly 400,000 working age adults are disabled (Leonard Cheshire Disability, 2011). Mobility impairment is one of the most common causes of disablement. Independent mobility is classed as a basic human right (United Nations, 1993), however 20 million disabled people worldwide are not receiving adequate assistive mobility technology (AMT) to facilitate this (WHO, 2008). At present there is limited data to facilitate provision of AMT on the basis of effectiveness and cost-effectiveness evidence. A Welsh Government (2010) wheelchair service report emphasised the need for validated outcome measures in the evaluation of AMT. Mobility impairments significantly affect health-related quality of life (HRQoL) related to old age and a wide range of conditions, including diabetic neuropathy (van Schie, 2008), traumatic brain injury (Williams and Willmott, 2012), spina bifida (Dicianno et al, 2009) and multiple sclerosis (Sutliff, 2010). Mobility impairments related to conditions such as cerebral palsy also have a significant impact on the HRQoL of children (Varni et al, 2007; Dobhal et al, 2013). In the UK the National Institute for Health and Care Excellence (NICE) provides independent guidance on health technologies, underpinned by the quality-adjusted life year (QALY) framework for evaluating efficiency of health services and treatments. QALYs allow comparison of varied and disparate interventions. Generic preference-based measures of HRQoL, such as EQ-5D (EuroQoL,1990), are used to calculate QALYs. At present generic measures lack sufficient precision in mobility impaired populations. For instance, the EQ 5D-5L mobility domain consists of five levels all related to walking, and thus does not account for mobility beyond walking, i.e. mobility achieved using AMT (Hagberg et al, 2015).The aim of this project is to develop the first preference-based mobility-related quality of life (QoL) outcome measure, which could be used to calculate QALYs for AMT. This will be called the MobQoL. By developing an appropriate preference-based measure sufficient sensitivity could be maintained, whilst allowing comparison with existing QALY data. This will have a wide range of applications across all forms of AMT, allowing NICE to appropriately scrutinise AMT and underpin commissioning decisions. A similar approach has been successful in visual impairment using the VisQoL measure (Misajon et al, 2005) which relates visual impairment to QoL, as the EQ-5D also lacks sensitivity in visual impairment. The project will be divided into four workstreams, each a key stage in outcome measure development: 1) a systematic review to understand the current state of literature in this field. 2) a qualitative exploration to inform the MobQoL questionnaire design: mobility impaired participants will be interviewed to disaggregate the concept of mobility into a novel descriptive system. 3) piloting and validating the MobQoL questionnaire through surveys. 4) developing and testing two value set scoring systems for the MobQoL; from a general population sample and a mobility impaired sample. The MobQoL will enhance the evidence base for the cost-effectiveness of AMT, which in turn could improve health service efficiency and service-user outcomes.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: GENERIC HEALTH RELEVANCE