TY - JOUR
T1 - What does/should the minimum clinically important difference measure?
T2 - A reconsideration of its clinical value in evaluating efficacy of lumbar fusion surgery
AU - Gatchel, Robert Joseph
AU - Mayer, Tom G.
AU - Chou, Roger
PY - 2012/6/1
Y1 - 2012/6/1
N2 - Objectives: The Minimum Clinical Important Difference (MCID) was initially intended to provide outcome measures that would be more clinically meaningful than measurements based simply on mean improvement in some outcomes. Indeed, a basic concept behind the MCID was that statistically significant differences in measures did not necessarily reflect clinically meaningful benefits. Methods: This study provides a review of the literature suggesting that the MCID metric is not being applied and interpreted in practice in a manner that realizes its potential. The MCID has often been used as a means of delineating whether patients are "feeling better." This does not, though, necessarily indicate that they are "doing better" in terms of physical or socioeconomic functioning. Results: The imperfect correlation between "feeling" and "doing" better makes it difficult to interpret the clinical implications of articles using MCID measures, particularly in the lumbar spine fusion literature. Alternative and more scientifically rigorous approaches to the MCID are presented. Discussion: A call is made for a more comprehensive approach to synthesize a nearly decade's worth of clinical research that has still not yielded consensus concerning the best MCID approach to objectively document lumbar spine fusion patients' outcomes.
AB - Objectives: The Minimum Clinical Important Difference (MCID) was initially intended to provide outcome measures that would be more clinically meaningful than measurements based simply on mean improvement in some outcomes. Indeed, a basic concept behind the MCID was that statistically significant differences in measures did not necessarily reflect clinically meaningful benefits. Methods: This study provides a review of the literature suggesting that the MCID metric is not being applied and interpreted in practice in a manner that realizes its potential. The MCID has often been used as a means of delineating whether patients are "feeling better." This does not, though, necessarily indicate that they are "doing better" in terms of physical or socioeconomic functioning. Results: The imperfect correlation between "feeling" and "doing" better makes it difficult to interpret the clinical implications of articles using MCID measures, particularly in the lumbar spine fusion literature. Alternative and more scientifically rigorous approaches to the MCID are presented. Discussion: A call is made for a more comprehensive approach to synthesize a nearly decade's worth of clinical research that has still not yielded consensus concerning the best MCID approach to objectively document lumbar spine fusion patients' outcomes.
KW - anchor-based method
KW - biopsychosocial
KW - clinically meaningful benefits
KW - distribution-based method
KW - lumbar spine fusion
KW - minimally important change
KW - minimum clinical important difference
UR - http://www.scopus.com/inward/record.url?scp=84861093436&partnerID=8YFLogxK
U2 - 10.1097/AJP.0b013e3182327f20
DO - 10.1097/AJP.0b013e3182327f20
M3 - Article
C2 - 22395333
AN - SCOPUS:84861093436
SN - 0749-8047
VL - 28
SP - 387
EP - 397
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 5
ER -