The Minimally Clinically Important Difference in Generic Utility-Based Measures Measurement of health status. Ascertaining the minimal clinically important difference. Minimal clinically important differences of 3 patient-rated outcomes instruments. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Testing minimal clinically important difference: consensus or conundrum? Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: secondary outcomes of a randomised controlled trial. The clinical relevance of changes in the Montgomery-Asberg Depression Rating Scale using the minimum clinically important difference approach. Validation of a consensus-based minimal clinically important difference (MCID) threshold using an objective functional external anchor. Time to deterioration in quality of life score as a modality of longitudinal analysis in patients with breast cancer. Outcomes of a Small Group Educational Intervention for Urinary Incontinence Using the standard error of measurement to identify important changes on the Asthma Quality of Life Questionnaire Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis. Determining the minimum clinically important differences for outcomes in the DOMINO trial. Assessing the clinical significance of health-related quality of life (HrQOL) improvements in anaemic cancer patients receiving epoetin alfa. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Evaluation of 3 quality of life measurement tools in patients with chronic heart failure.
Purpose : To evaluate the use of utility-based generic quality of life measures for establishing the minimally clinical ly important difference ( MCID ) . Background : Utility-based quality of life measures place levels of wellness on a continuum anchored by death ( 0.00 ) and optimum function ( 1.00 ) . Preference measurement studies are used to define the meaning of points along the continuum . Health states that differ by less than 0.03 units can not be discriminated by panels of judges as different from one another . Thus , 0.03 is a reasonable MCID for these measures . Method : Three published studies of patients with Chronic Obstructive Pulmonary Disease ( COPD ) reported data on the Quality of Well-being Scale ( QWB ) before and after pulmonary rehabilitation . One of the studies also r and omly assigned patients to lung volume reduction surgery or to maximal medical therapy . These patients were followed for an average of 29 months . Results : All three evaluations of pulmonary rehabilitation showed changes on the QWB in excess of the proposed 0.03 MCID . QWB changes for patients assigned to lung volume reduction surgery were close to the MCID threshold at one year but grew stronger in subsequent years . Using Norman 's 0.50 st and ard deviation method , all three estimates of rehabilitation effectiveness and the outcomes one year following surgery fall below the MCID . Conclusion : Different methods for estimating MCID lead to different conclusions about the meaning of quality of life changes following pulmonary rehabilitation and lung volume reduction surgery . The preference scaling system in generic utility-based quality of life measures provides a metric that is directly interpretable and avoids many of the criticisms of MCID measures . The method is sensitive enough to suggest clinical ly meaningful benefits of rehabilitation and surgery . Further , quality adjusted life years offer a valuable metric for policy analysis . Utility-based measures of health related quality of life should gain greater use in COPD outcomes research In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials PURPOSE Patient-rated instruments are increasingly used to measure orthopedic outcomes . However , the clinical relevance of modest score changes on such instruments is often unclear . This study was design ed to define the minimal clinical ly important differences ( MCIDs ) of the Disabilities of the Arm , Shoulder , and H and ( DASH ) , QuickDASH ( subset of DASH ) , and Patient-Rated Wrist Evaluation ( PRWE ) question naires for atraumatic conditions of the h and , wrist , and forearm . METHODS We prospect ively analyzed 102 patients undergoing nonoperative treatment for isolated tendinitis , arthritis , or nerve compression syndromes from the forearm to the h and . By phone , patients completed the DASH , QuickDASH , and PRWE at enrollment and at 2 weeks ( n = 78 used in the analysis ) and 4 weeks ( n = 24 used in the analysis ) after initiating treatment . Patients reporting clinical improvement each contributed a single data point categorized as no change ( n = 41 ) , minimal improvement ( n = 30 ) , or marked improvement ( n = 31 ) via a vali date d anchor-based approach . We calculated the MCID as the mean change score for each outcome measure in the minimal improvement group . RESULTS The MCID ( 95 % confidence interval ) for the DASH was 10 ( 5 - 15 ) . The MCID for the QuickDASH was 14 ( 9 - 20 ) . The MCID was 14 ( 8 - 20 ) for the PRWE . The MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement . The MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores . CONCLUSIONS Longitudinal changes on the DASH of 10 points , on the QuickDASH of 14 points , and on the PRWE of 14 points represent minimal clinical ly important changes . We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients . These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures . TYPE OF STUDY /LEVEL OF EVIDENCE Diagnostic III OBJECTIVE To compare the st and ard error of measurement ( SEM ) with established st and ards for clinical ly relevant intra-individual change in an evaluation of health-related quality of life . DESIGN Secondary analysis of data from a r and omized controlled trial . SUBJECTS Six hundred and five out patients with a history of cardiac problems attending the general medicine clinics of a major academic medical center . MEASURES Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Question naire ( CHQ )  and the SF-36 .  The SEM values corresponding to established st and ards for minimal clinical ly important differences ( MCIDs ) on the CHQ were determined . Individual change on the SF-36 was explored using the same SEM criterion . RESULTS One-SEM changes in this population corresponded well to the patient-driven MCID st and ards on all CHQ dimensions ( weighted kappas ( 0.87 ; P < 0.001 ) . The distributions of out patients who improved , remained stable , or declined ( defined by the one-SEM criterion ) were generally consistent between CHQ dimensions and SF-36 subscales . CONCLUSIONS The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established st and ards for clinical ly relevant differences . Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinical ly meaningful change BACKGROUND CONTEXT Various method ologies have been used in attempting to eluci date a st and ard method for calculating minimal clinical ly important difference ( MCID ) . A consensus-based decision ( Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials [ IMMPACT ] group ) suggested a 30 % reduction from baseline as a means to define the MCID of self-report back pain measures . Additionally , important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion , instead of simply using another self-report measure , when using an anchor-based approach to MCID . PURPOSE The purpose was to test the validity of recently published guidelines regarding MCID using self-report back pain measures and objective socioeconomic outcomes . STUDY DESIGN / SETTING This is a prospect i ve study assessing change scores on commonly used spinal pain assessment measures in patients with chronic disabling occupational spinal disorders ( CDOSDs ) treated in a regional referral rehabilitation center performing interdisciplinary functional restoration . PATIENT SAMPLE The study consisted of consecutive cohort of patients ( N=1,180 ) with CDOSDs completing a functional restoration program . OUTCOMES MEASURES Self-report measures including the Oswestry Disability Index ( ODI ) and the physical component summary ( PCS ) and mental component summary ( MCS ) of the Short Form-36 ( SF-36 ) obtained before and after treatment , were compared with objective socioeconomically relevant outcomes obtained 1 year after treatment ( ie , work status and additional health-care utilization ) , that were the external criteria for evaluating MCID . METHODS Pre- to posttreatment improvement was calculated separately for each measure , and subjects were divided into two groups based on the change in scores relative to baseline : 30 % or greater versus less than 30 % improvement . One-year posttreatment objective socioeconomic outcomes were used as independent external criteria relevant to the CDOSD population . This population is often studied as the most costly and problematic cohort in spine care . RESULTS The ODI and SF-36 MCS were not associated with any of the objective 1-year outcomes used as external criteria . Reduced post-rehabilitation health-care utilization ( based on the percentage of patients pursuing health care from a new provider ) was weakly associated with 30 % or greater improvement on the SF-36 PCS , relative to patients whose scores changed by less than 30 % relative to baseline ( 17.0 % vs. 21.1 % ) . The same was true for the ODI and return-to-work . CONCLUSIONS When objective and independent criteria are used ( socioeconomic outcomes ) in a CDOSD cohort , the 30 % improvement in the ODI and SF-36 may not be a valid MCID index . This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID . The validity of the MCID concept rests on future research using objective external criteria . Moreover , there remains a question whether the term " important " in MCID can be unequivocally and operationally defined as a reliable construct Background Guidelines and experts describe 5 % to 10 % reductions in body weight as ` clinical ly important ’ ; however , it is not clear if 5 % to 10 % weight reductions correspond to clinical ly important improvements in health-related quality of life ( HRQL ) . Our objective was to calculate the amount of weight loss required to attain established minimal clinical ly important differences ( MCIDs ) in HRQL , measured using three vali date d instruments . Methods Data from the Alberta Population -based Prospect i ve Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery ( APPLES ) study , a population -based , prospect i ve Canadian cohort including 150 wait-listed , 200 medically managed and 150 surgically treated patients were examined . Two-year changes in weight and HRQL measures ( Short-Form (SF)-12 physical ( PCS ; MCID = 5 ) and mental ( MCS ; MCID = 5 ) component summary score , EQ-5D Index ( MCID = 0.03 ) and Visual Analog Scale ( VAS ; MCID = 10 ) , Impact of Weight on Quality of Life (IWQOL)-Lite total score ( MCID = 12 ) ) were calculated . Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs . Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument . Results Mean age was 43.7 ( SD 9.6 ) years , 88 % were women , 92 % were white , and mean initial body mass index was 47.9 ( SD 8.1 ) kg/m2 . In surgically treated patients ( two-year weight loss = 16 % ) , HRQL MCIDs were reached for all instruments except the SF-12 MCS . In medically managed patients ( two-year weight loss = 3 % ) , MCIDs were attained in the EQ-index but not the other instruments . In all patients , percent weight reductions to achieve MCIDs were : 23 % ( 95 % confidence interval ( CI ) : 17.5 , 32.5 ) for PCS , 25 % ( 17.5 , 40.2 ) for MCS , 9 % ( 6.2 , 15.0 ) for EQ-Index , 23 % ( 17.3 , 36.1 ) for EQ-VAS , and 17 % ( 14.1 , 20.4 ) for IWQOL-Lite total score . Conclusions Weight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5 % to 10 % . Surgical , but not medical treatment , consistently led to clinical ly important improvements in HRQL over two years . Trial registration Clinical trials.gov NCT00850356 INTRODUCTION AND AIM In a r and omised trial investigating the effects of regular use of  health-related quality of life ( HRQOL )  in oncology practice , we previously reported an improvement in communication ( objective analysis of recorded encounters ) and patient well-being . The secondary aims of the trial were to measure any impact on patient satisfaction and patients ' perspectives on continuity and coordination of their care . METHODS In a prospect i ve trial involving 28 oncologists , 286 cancer patients were r and omised to : ( 1 ) intervention arm : regular touch-screen completion of HRQOL with feedback to physicians ; ( 2 ) attention-control arm : completion of HRQOL without feedback ; and ( 3 ) control arm : no HRQOL assessment . Secondary outcomes were patients ' experience of continuity of care ( Medical Care Question naire , MCQ ) including ' Communication ' , ' Coordination ' and ' Preferences to see usual doctor ' subscales , patients ' satisfaction , and patients ' and physicians ' evaluation of the intervention . Analysis employed mixed-effects modelling , multiple regression and descriptive statistics . RESULTS Patients in the intervention arm rated their continuity of care as better than the control group for ' Communication ' subscale ( p=0.03 ) . No significant effects were found for ' Coordination ' or ' Preferences to see usual doctor ' . Patients ' evaluation of the intervention was positive . More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group ( 86 % versus 29 % ) , and reported their doctors considered daily activities , emotions and quality of life . CONCLUSION Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients . HRQOL data may improve care through facilitating rapport and building inter-personal relationships OBJECTIVE To identify the minimal clinical ly important difference ( MCID ) for the Montgomery-Asberg Depression Rating Scale ( MADRS ) in r and omised studies of depression , and to cross-vali date the estimated MCID . DESIGN AND METHODS  Placebo-treated patients from three similarly- design ed , 8-week , double-blind , r and omised depression trials with a stable health status between baseline and Week 1 ( ' no change ' rating on the Clinical Global Impression-Improvement scale ) were eligible . To calculate the MCID using the distribution-based approach , the st and ard deviation was estimated using baseline MADRS data while the reliability parameter was measured as the intraclass correlation coefficient between baseline and Week 1 . For cross-validation , patients from an observational study were matched to identify the ' MCID  change ' ( MADRS change from baseline to endpoint score plus the estimated MCID ) and ' control ' groups . Comparisons of clinical and health-related quality of life measures were performed . RESULTS In total , 177 placebo-treated patients were identified .  MCID estimates for MADRS ranged from 1.6 to 1.9 . A total of 105 matched pairs were identified for the cross-validation analyses . Mean change from baseline in MADRS scores ( 10.6 + /- 8.5 vs. 12.5 + /- 7.9 , p = 0.038 ) and remission rates ( 71.6 % vs. 57.1 % , p < 0.05 ) significantly differed between the ' MCID change ' and ' control ' groups at endpoint . Numerically higher response rates and greater improvements in HRQoL scores in the ' MCID change ' group were also found . CONCLUSION These preliminary findings support the value of the estimated MCID for the MADRS and may aid decision makers in evaluating antidepressant treatment effects and improving long-term patient outcomes BACKGROUND CONTEXT The minimal clinical ly important difference ( MCID ) is defined as the smallest change in an outcome that a patient would perceive as meaningful . The Initiative on Methods , Measurement and Assessment in Clinical Trials ( IMMPACT ) group proposed defining the MCID as a 30 % improvement in self-reported pain or function . However , this MCID threshold has not been vali date d against an objective physical measure . PURPOSE To test the validity of the IMMPACT-based MCID threshold , using an objective physical measure as an external anchor . STUDY DESIGN / SETTING Prospect i ve study of chronic disabling occupational lumbar disorder ( CDOLD ) patients completing a functional restoration program . PATIENT SAMPLE A consecutive cohort of 743 CDOLD patients . OUTCOME MEASURES Self-report measures of pain-related function were compared with an objective lifting measure , the progressive isoinertial lifting evaluation ( PILE ) , obtained after treatment . METHODS The association between reporting 30 % or greater improvement ( the IMMPACT 's MCID key criterion ) and the PILE score after treatment was assessed . RESULTS A 30 % or greater improvement on the self-report measures was significantly associated with improvement in physical function on the PILE task . CONCLUSIONS Despite extensive use of the MCID to evaluate effects of treatment in spinal disorders , this is the first empirical documentation of the validity of the IMMPACT 's 30 % change criterion compared with an objective physical anchor PURPOSE This prospect i ve multicenter study explored different definitions of time to deterioration ( TTD ) in quality of life ( QoL ) scores , according to different cutoffs of the minimal clinical ly important difference ( MCID ) as a modality for longitudinal QoL assessment in breast cancer patients .  METHODS QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Question naire C30 and BR-23 before surgery , after surgery , and 6 and 12 months later . The global health score , arm symptoms score ( BRAS ) , and breast symptoms score were analyzed . For a given baseline score , QoL was considered to have deteriorated if this score decreased by ≥5 points at any time point after baseline . Analyses were repeated using an MCID of 10 points and taking the score after surgery as the reference score ( to explore the occurrence of response shift ) . TTD was calculated using the Kaplan-Meier method and Cox regression was used to identify independent factors associated with TTD . RESULTS Two hundred thirty-five patients underwent axillary lymph node dissection ( ALND ) , 222 underwent sentinel lymph node biopsy ( SLNB ) , and 61 underwent SLNB plus ALND . Patients who underwent SLNB had a significantly longer TTD for the BRAS dimension than those who underwent ALND . Cox multivariate analyses showed that treatment using SLNB and age > 59 years were independently associated with longer TTD for the BRAS , whereas surgery elsewhere than at the Centre Georges François Leclerc was associated with a shorter TTD . CONCLUSION Exploration of different definitions of TTD in QoL provides meaningful longitudinal QoL results for clinicians Objectives : This article examines change in general and condition-specific measures of health-related quality of life ( HRQL ) among participants in a r and omized trial of a community-based intervention for urinary incontinence ( UI ) . Methods : Participants were r and omized into intervention or wait control conditions . Participants were women aged 65 or older with urinary incontinence residing in Oklahoma . General HRQL measures included the Physical Function , Mental Health , Vitality , and Health Perceptions subscales of the Medical Outcomes Study Short Form–36 . Condition-specific measures included the Impact of UI and self-management strategies . Results : There were no significant group effects for the general HRQL measures . Intervention participants reported decreased Impact of UI and greater change in self-management strategies than control participants . Discussion : The intervention affected condition-specific quality of life and self-management but not general HRQL . The intervention ’s impact on quality of life involves change in howthe condition is seen as impacting on life and on selection of self-management behaviors Objectives : To establish a link between the minimal important difference ( MID ) and the st and ard error of measurement ( SEM ) for all responsive dimensions of the Asthma Quality of Life Question naire ( AQLQ ) . Methods : Secondary data analysis of baseline and follow-up interview data from 198 out patients with asthma enrolled in a r and omized controlled trial and receiving care at a major urban academic medical center 's general medicine clinics . Domain statistics for baseline and follow-up interviews were examined for the AQLQ . The baseline SEM values were compared with established AQLQ MID st and ards using weighted κ values . Results : One SEM identified the MID in responsive AQLQ dimensions . Weighted κ values ( 0.88–0.93 ) vali date d excellent agreement between these two criteria . Conclusion : This is the third study to support using one SEM to identify important individual change in health-related quality of life ( HRQoL ) measures . However , refinement of the process for determining a measure 's clinical ly meaningful differences is still needed to secure a link between the SEM and the identification of relevant HRQoL change over time BACKGROUND The 5-dimensional EuroQol question naire ( EQ-5D ) is vali date d to measure general health-related quality of life ( QOL ) . Our objective was to determine the responsiveness and minimal clinical ly important difference ( MCID ) of the EQ-5D health utility value ( EQ-5D HUV ) and visual analog scale ( EQ-5D VAS ) in chronic rhinosinusitis ( CRS ) . METHODS 203 adults undergoing medical management for CRS were prospect ively recruited . General health-related QOL ( using EQ-5D HUV and EQ-5D VAS ) and CRS-specific QOL ( using the 22-item Sinonasal Outcome Test [ SNOT-22 ] ) were measured at enrollment and a subsequent follow-up time point 2 - 12 months later . At follow-up , participants also rated change in general health as Much worse , A little worse , About the same , A little better or Much better compared to enrollment . The EQ-5D HUV and EQ-5D VAS MCIDs were calculated using distribution-based , anchor-based , and receiver operator characteristic ( ROC ) curve-based methods . RESULTS Change in SNOT-22 score was correlated with EQ-5D HUV and EQ-5D VAS change . Using the different methods of calculating MCID , we find the EQ-5D HUV MCID to be 0.04 and EQ-5D VAS MCID to be 8.0 . The calculated EQ-5D MCIDs had approximately a sensitivity of 40 - 50 % and specificity of 80 % in detecting patients experiencing noticeable improvement in general health . CONCLUSIONS The EQ-5D responds well to changing CRS symptomatology . We propose MCIDs for EQ-5D HUV of 0.04 and EQ-5D VAS of 8 in CRS patients , which although specific , are not sensitive for detecting patients experiencing improvement in general health BACKGROUND Although less likely to be reported in clinical trials than expressions of the statistical significance of differences in outcomes , whether or not a treatment has delivered a specified minimum clinical ly important difference ( MCID ) is also relevant to patients and their caregivers and doctors . Many dementia treatment r and omised controlled trials ( RCTs ) have not reported MCIDs and , where they have been done , observed differences have not reached these . METHODS As part of the development of the Statistical Analysis Plan for the DOMINO trial , investigators met to consider expert opinion- and distribution-based values for the MCID and triangulated these to provide appropriate values for three outcome measures , the  St and ardised Mini-mental State Examination ( sMMSE ) , Bristol Activities of Daily Living Scale ( BADLS ) and Neuropsychiatric Inventory ( NPI ) . Only st and ard deviations ( SD ) were presented to investigators who remained blind to treatment allocation . RESULTS Adoption of values for MCIDs based upon 0.4 of the SD of the change in score from baseline on the sMMSE , BADLS and NPI in the first 127 participants to complete DOMINO yielded MCIDs of 1.4 points for sMMSE , 3.5 for BADLS and 8.0 for NPI . CONCLUSIONS Reference to MCIDs is important for the full interpretation of the results of dementia trials and those conducting such trials should be open about the way in which they have determined and chosen their values for the MCIDs Health-related quality of life ( HrQOL ) assessment s are gaining importance as outcome measures in cancer clinical trials . A recently published clinical trial reported statistically significant ( P<0.001 ) increases in haemoglobin ( Hb ) levels and significantly ( P<0.01 ) increased HrQOL scores following the administration of recombinant human erythropoietin ( r-HuEPO , epoetin alfa ) versus placebo to anaemic cancer patients who received non-platinum chemotherapy . This study employed five cancer-specific HrQOL instruments . Hb and HrQOL data from this trial were analysed to estimate the minimally important difference ( MID ) in HrQOL measures that could be interpreted as clinical ly meaningful , with Hb level selected as the best external st and ard . Patients were assigned to two groups : improved ( Hb increases of > /=1 g/dL ) or stable ( change in Hb of-1 g/dL to < 1 g/dL ) . The MID was first determined as the difference between the mean changes in HrQOL in the improved group versus the stable group . By this analysis , the differences in HrQOL scores between the epoetin alfa group and the placebo group were clinical ly important for all Hb-sensitive , cancer-specific HrQOL evaluations . Linear regression analyses performed to provide estimates of the MID for specific values of Hb change confirmed that the differences in HrQOL scores between patient groups were clinical ly significant . These analyses were repeated using a data set from a separate clinical trial , which further supported the conclusion that observed HrQOL changes demonstrated in the multicentre , double-blind study were clinical ly important . These methods provide one means for interpreting the clinical relevance of changes in HrQOL evaluated in clinical trials BACKGROUND CONTEXT The impact of  lumbar spinal surgery  is commonly evaluated with three patient-reported outcome measures : Oswestry Disability Index ( ODI ) , the physical component summary ( PCS ) of the Short Form of the Medical Outcomes Study ( SF-36 ) , and pain scales . A minimum clinical ly important difference ( MCID ) is a threshold used to measure the effect of clinical treatments . Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method . PURPOSE This study has three purpose s. First , to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID . Second , to determine a statistically sound and clinical ly meaningful MCID for ODI , PCS , back pain scale , and leg pain scale in lumbar spine surgery patients . Third , to compare the discriminative ability of two anchors : a global health assessment and a rating of satisfaction with the results of the surgery . STUDY DESIGN This study is a review of prospect ively collected patient-reported outcomes data . PATIENT SAMPLE A total of 454 patients from a large data base of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study . OUTCOME MEASURES Preoperative and 1-year postoperative scores for ODI , PCS , back pain scale , leg pain scale , health transition item ( HTI ) of the SF-36 , and Satisfaction with Results scales . METHODS ODI , SF-36 , and pain scales were administered before and 1 year after spinal surgery . Several c and i date MCID calculation methods were applied to the data and the result ing values were compared . The HTI of the SF-36 was used as the anchor and compared with a second anchor ( Satisfaction with Results scale ) . RESULTS Potential MCID calculations yielded a range of values : fivefold for ODI , PCS , and leg pain , 10-fold for back pain . Threshold values obtained with the two anchors were very similar . CONCLUSIONS The minimum detectable change ( MDC ) appears as a statistically and clinical ly appropriate MCID value . MCID values in this sample were 12.8 points for ODI , 4.9 points for PCS , 1.2 points for back pain , and 1.6 points for leg pain OBJECTIVE The objectives of this study are to ( 1 ) Address issues related to selecting a quality of life ( QOL ) measuring tool ; and ( 2 ) Present data from a pilot test comparing 3 QOL tools ( Medical Outcomes Study Short Form-36 [ SF-36 ] , the Minnesota Living with Heart Failure Question naire [ LHFQ ] , and a visual analogue scale ) . DESIGN Descriptive comparative . SETTING A Southern university-affiliated tertiary medical center outpatient heart failure clinic . PATIENTS Thirty adults , r and omly selected from those treated in a multidisciplinary , nurse practitioner-managed heart failure clinic . RESULTS Significant correlations were found among the global or broader measures of QOL ( visual analog scale and LHFQ Total score ) and the component scores ( LHFQ Emotional , LHFQ Physical , SF-36 Mental [ MCS ] , and SF-36 Physical [ PCS ] ) , with the only exception being that of the LHFQ Total and the SF-36 PCS . Mental and physical components of QOL were not related within the SF-36 or between the SF-36 PCS and the LHFQ Emotional score . However , the emotional and physical scores were highly and significantly related within the LHFQ and between the SF-36 MCS and the LHFQ Physical score . CONCLUSIONS The SF-36 was better able to differentiate physical and emotional aspects of QOL in this sample . The LHFQ subscales may be less useful in QOL assessment than the total score
We observed a lack of consistency in the application of methods for computing MID or MCID for generic and disease-specific HRQoL measures .
The anchor-based method yields conservative estimates of MID or MCID , compared to the distribution-based method .
OBJECTIVES The objective of the study was to assess the usability of minimal important difference ( MID ) and minimal clinical ly important difference ( MCID ) for measuring meaningful changes in disease-specific and generic health-related quality -of-life ( HRQoL ) outcomes in patient-centered care .