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Practical Examples
Published in Mitchell G. Maltenfort, Camilo Restrepo, Antonia F. Chen, Statistical Reasoning for Surgeons, 2020
Mitchell G. Maltenfort, Camilo Restrepo, Antonia F. Chen
The minimal clinically important difference (MCID), also called the minimally important difference, is the least change in a PRO that can have a meaningful result to a patient. As with the blood loss during surgery, this seems a simple concept. There are at least nine ways of estimating this simple concept [40]. Some methods focus on estimating the smallest change that can be statistically determined from the available data, a version of the MCID that is also called the minimum detectable difference or MDC. Other methods estimate the MCID as the difference in change scores between patients reporting improvement and those reporting no improvement. There is also an approach based on the receiver operating characteristic (ROC) curve, where the ROC curve is used to select the change in PRO score optimally associated with classification into “improved” or “not improved.” Further considering that different studies might use different definitions for improvement and that there can be variations between clinical groups such as the type of treatment and the reason for treatment, there can be considerable variations among MCID estimates (reviewed in [41]).
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective Multicenter, Propensity-Matched Cohort Assessment with Minimum 2-Year Follow-Up *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Ryan P. McLynn, Jonathan N. Grauer
Patients in the operative group also demonstrated significant improvement in all HRQOL assessments, and the effect size was at least one minimal clinically important difference (MCID, based on values reported in previous studies) in all measures for which MCID was reported. The nonoperative group demonstrated improvements in the SRS-22r pain domain and satisfaction domain, but no change in other HRQOL measures. The proportion of patients improving by ≥1 MCID was significantly greater for all HRQOL measures in the operative group (p <0.001).
Development of complex interventions
Published in David A. Richards, Ingalill Rahm Hallberg, Complex Interventions in Health, 2015
Susanne Buhse, Ingrid Mühlhauser
The concept of minimal clinically important difference (MCID) or minimal important difference (MID) should be used to facilitate interpretation of the data. It is defined as ‘patient derived scores that reflect changes in a clinical intervention that are meaningful for the patient’ (Jaeschke et al., 1989: 407) or ‘the smallest difference between two measurement results that a patient considers relevant’ (Brettschneider et al., 2011). Defining a MCID or MID can be a challenge, since it varies across different interventions, study populations and other contextual factors. In terms of PROs, the FDA established the term ‘responder’ in order to focus on meaningful changes at the individual level (FDA, 2009). There are multiple statistical approaches to estimate important clinical differences and responder thresholds, for example anchor-based estimates (using external clinical or patient-based indicators that reflect changes) and distribution-based methods (distribution of observed scores) (FDA, 2009).
Body mass index and quality of life in people living with HIV
Published in AIDS Care, 2023
Jennifer Ken-Opurum, Girish Prajapati, Joana E. Matos, Swarnali Goswami, Princy Kumar
HRQoL measures included the Short Form 36-Item Health Survey Version 2 (SF-36v2) (Ware et al., 2002) and the 5-level EQ-5D version (EQ-5D-5L) (Herdman et al., 2011). The SF-36v2 is a multipurpose, generic health status instrument comprised of 36 questions, mapping onto eight different health domains: physical functioning, physical role limitations, bodily pain, general health, vitality, social functioning, emotional role limitations, and mental health. Two summary scores were reported: the physical component summary (PCS, scale of 0–100) and the mental component summary (MCS, scale of 0–100). Each domain/summary score is normed to a mean of 50 with standard deviation of 10 for the general US population, with higher scores implying better health status (Ware et al., 2002). The minimal clinically important difference (MCID) for the PCS and MCS have been found to range from two to five points (Strand & Crawford, 2014; Ware et al., 2007; Warkentin et al., 2014; Zanini et al., 2015).
The minimal clinically important difference of the Southampton Dupuytren’s Scoring Scheme
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Jens Jørgsholm, Rasmus Wejnold Jørgensen
Patient-reported outcome measures (PROM) are useful for the evaluation of outcome following treatment. The minimal clinically important difference (MCID) is intended to clarify clinical significance or relevance in PROM score interpretation. MCID reflects the minimal difference in the score that is meaningful to the patient [1]. In other terms the change in scores after treatment may be statistically significant, but not considered worthwhile by the patient. There are two main approaches used to calculate the MCID. The anchor-based and the distribution-based method. The anchor-based method relies on an external criterion (anchor) to determine if a change in the outcome score is clinically important. The distribution-based method depends on statistical characteristics of a sample and describes the ability to detect changes in general.
Randomised controlled trial of interventions for bothersome tinnitus: DesyncraTM versus cognitive behavioural therapy
Published in International Journal of Audiology, 2022
Sarah M. Theodoroff, Garnett P. McMillan, Caroline J. Schmidt, Serena M. Dann, Christian Hauptmann, Marie-Christine Goodworth, Ruth Q. Leibowitz, Chan Random, James A. Henry
As mentioned in the Methods section, the TQ was designed to capture change in tinnitus distress. After determining a change is present, the next important question to ask is how much of a change in the TQ score is needed before a patient would notice a clinically meaningful change in whatever aspect they perceive to be bothersome about their tinnitus. Similarly, a clinician and patient must collectively decide how much of a difference in predicted TQ outcomes is required to make one treatment more worthwhile than the other. This concept is known as the minimal clinically important difference (MCID). Researchers and clinicians have reported a range of MCID values for the TQ. Hall, Mehta, and Argstatter (2018) re-evaluated this issue and found that although many clinicians use a minimum cut-off of 5 points, in order to be confident that a patient would notice an MCID, the MCID for the change over time in individual patients should be increased to a reduction of at least 12 points. It is questionable if the difference in expected treatment outcomes between Desyncra and CBT, which this clinical trial found to be on the order of 3 to 6 points, would make a dramatic difference to an individual patient.