Journal
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 101, Issue 6, Pages 1090-1094Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2019.12.008
Keywords
Minimal clinically important difference; Outcome and process assessment, health care; Patient outcome assessment; Quality of health care; Rehabilitation
Categories
Funding
- National Institute on Disability, Independent Living, and Rehabilitation Research-Traumatic Brain Injury National Data and Statistical Center [90DP0084]
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The minimal clinically important difference (MCID) is receiving increasing interest and importance in medical practice and research. The MCID is the smallest improvement in scores in the domain of interest that patients perceive as beneficial. In clinical trials, comparing the proportion of individuals between treatment and control groups who obtain a MCID may be more informative than comparisons of mean change between groups because a statistically significant mean difference does not necessarily represent a difference that is perceived as meaningful by treatment recipients. The MCID may also be useful in advancing personalized medicine by characterizing those who are most likely to benefit from a treatment. In clinical practice, the MCID can be used to identify if a participant is experiencing a meaningful change in status. A variety of methods have been used to determine the MCID with no clear agreement on the most appropriate approach. Two major sets of methods are either (1) distribution-based, that is, referencing the MCID to a measure of variability or effect size in the measure of interest or (2) anchor-based, that is, referencing the MCID to an external assessment of change in the condition, ability, or activity represented by the measure of interest. In prior literature, using multiple methods to triangulate on the value of the MCID has been proposed. In this commentary, we describe a systematic approach to triangulate on the MCID using both distribution-based and anchor-based methods. Adaptation of a systematic approach for obtaining the MCID in rehabilitation would facilitate communication and comparison of results among rehabilitation researchers and providers. (C) 2020 by the American Congress of Rehabilitation Medicine
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