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Use of EUROQOL-5D (EQ-5D) in orthopaedic trauma trials #NDORMS-2020/4

About This PhD Project

Project Description

Research Project Outline

Health related quality of life is commonly measured in clinical research studies including Randomised Controlled Trials (RCTs). Perhaps the most commonly used to do this is the Euroqol-5 dimensions (EQ-5D) questionnaire (1). It comprises of two elements, five questions which comprise the descriptive system and can be used to produce a utility score, and the EQ-Visual Analogue Scale (EQ-VAS), a single overall assessment of quality related health. The original EQ-5D-3L questionnaire had 3 response options for each of the 5 dimension questions, and the more recently produced EQ-5D-5L has 5 response levels. Typically within a trial the descriptive system is given pre-eminence with population norms applied to produce a utility score which can be used as the based to calculate quality adjusted life years (QALYs) within a cost-effectiveness framework (2). The advantage is that this allows comparisons across medical areas and an assessment of the comparative cost per QALY amongst other metrics. However, this is not without controversy, as for many areas it is disputed whether the EQ-5D is sensitivity enough to pick up a clinically important difference hence why condition or health domain specific measures are often used (3). Furthermore, it could be argued in terms of some choices where the costs are relatively neutral, the reference population of interest is the condition specific one. Orthopaedic trauma patients, in particular those who have fractured their hip, provide an interest subpopulation. This includes some relatively common conditions where the treatments have sizeable effects as measured on the EQ-5D, and the mortality within 1 year of the injury is relatively high. Furthermore, large populations and trial datasets are available with EQ-5D data (4). This DPhil aims to explore the use of the EQ-5D within this setting and its valuation. Elements of research will include a review of current practice including a systematic review of practice in clinical studies of this condition, undertaking an evaluation of the EQ-5D scoring using this condition as the population, and an evaluation of the impact of such a scoring on trial findings.


The supervisory team will include Jonathan A Cook ( and Xavier Griffin (

Associate Professor Jonathan A Cook is a hilghly experienced clinical trial statistician with a particular interest in the conduct of surgical trials. He has lead out a number of methodological research project related to surgical trial design and the design and analysis of randomised trials.

Associate Professor Xavier Griffin is an experience orthopaedic clinical trialist with an interest in the methodology of clinical trials.


The Botnar Research Centre plays host to the University of Oxford's Institute of Musculoskeletal Sciences, which enables and encourages research and education into the causes of musculoskeletal disease and their treatment. The proposed project will be part of the statistical methodology work in the Centre for Statistics in Medicine ( Training will be provided in techniques including systematic reviewing, critiquing clinical trial methodology, and evaluating the value of statistical methods in practice.

A core curriculum of lectures will be taken in the first term to provide a solid foundation in a broad range of subjects including musculoskeletal biology, inflammation, epigenetics, translational immunology, data analysis and the microbiome. Students will also be required to attend regular seminars within the Department and those relevant in the wider University.

Students will be expected to present data regularly in Departmental seminars, the CSM and to attend external conferences to present their research globally, with limited financial support from the Department.

Students will also have the opportunity to work closely with the CSM.

Students will have access to various courses run by the CSM, Medical Sciences Division Skills Training Team and other Departments. All students are required to attend a 2-day Statistical and Experimental Design course at NDORMS and run by the IT department (information will be provided once accepted to the programme).

How to Apply

The Department accepts applications throughout the year but it is recommended that, in the first instance, you contact the relevant supervisor(s) or the Graduate Studies Officer, Sam Burnell (), who will be able to advise you of the essential requirements.

Interested applicants should have, or expect to obtain, a first or upper second-class BSc degree or equivalent in a relevant subject and will also need to provide evidence of English language competence (where applicable). The application guide and form is found online and the DPhil or MSc by research will commence in October 2020.

Applications should be made to one of the following programmes using the specified course code:
D.Phil in Musculoskeletal Sciences (course code: RD_ML2)

For further information, please visit


2. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health‐related quality of life: An EQ‐5D‐5L value set for England. Health Economics 2018;27:7-22.
3. Copsey B, Dutton S, Fitzpatrick R, Lamb SE, Cook JA. Problems persist in reporting of methods and results for the WOMAC measure in hip and knee osteoarthritis trials. QOLR [published online] 18 September 2018
4. Griffin XL, Achten J, Sones W, Cook JA, Costa ML. Protocol for WHiTE Four (WHiTE4): A randomised controlled trial of the sliding hip screw versus X-Bolt dynamic plating system for the fixation of trochanteric fractures of the hip in adults. BMJ Open 2018 Jan 26;8(1):e019944.

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