Baseline Dependency of Minimal Clinically Important Improvement.
Background. Minimal clinically important improvement (MCII) is the smallest outcome measure change important to patients. Research suggests that MCII is dependent on patients' baseline functional status measures. Objective. The purposes of this study were: (1) to confirm whether MCII is dependent on...
| Publicado en: | Physical Therapy Vol. 91; no. 5; pp. 675 - 689 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
May2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104898562&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104898562 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00319023 PTH jtl: Physical Therapy issn: 00319023 maglogo: N pubinfo: dt: May2011 vid: 91 iid: 5 pid: 10398 pub: Oxford University Press / USA artinfo: ui: 104898562 60677567 10.2522/ptj.20100229 NLM21372203 104898562 ppf: 675 ppct: 14 formats: fmt: @attributes: type: P tig: atl: Baseline Dependency of Minimal Clinically Important Improvement. aug: au: Wang, Ying-Chih Hart, Dennis L. Stratford, Paul W. Mioduski, Jerome E. affil: Assistant Professor, Department of Occupational Science and Technology, University of Wisconsin--Milwaukee, Milwaukee, Wisconsin; Senior Data Analyst, Focus On Therapeutic Outcomes, Inc, Knoxville, Tennessee; Adjunct Faculty, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois sug: subj: Outcome Assessment Functional Status Knee Joint Pathology Musculoskeletal Diseases Physiopathology Measurement Issues and Assessments Human Prospective Studies Demography Scales Summated Rating Scaling Secondary Analysis Nonexperimental Studies Computerized Adaptive Testing International Classification of Functioning, Disability, and Health Effect Size ROC Curve Confidence Intervals Adult Middle Age Sensitivity and Specificity Female Male P-Value Clinical Assessment Tools Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Background. Minimal clinically important improvement (MCII) is the smallest outcome measure change important to patients. Research suggests that MCII is dependent on patients' baseline functional status measures. Objective. The purposes of this study were: (1) to confirm whether MCII is dependent on patients' admission scores and (2) to test whether MCII is dependent on selected demographic characteristics. Study Design and Setting. This was a prospective, longitudinal, observational cohort study of 6,651 patients with orthopedic knee impairments treated in 332 outpatient rehabilitation clinics in 27 states in the United States. Outcome Measures. Patient self-reports of functional status (FS) from the Lower Extremity Functional Scale were assessed using a computerized adaptive testing application (0-100 scale). Methods. An anchored-based longitudinal method, with a 15-point Likert-type scale (-7 to +7), was used to provide a global rating of change (GROC). The MCII threshold for the GROC was defined at a cut-score of +3 or greater and was determined using nonparametric receiver operating characteristic curve analysis for each of the following variables: sex, symptom acuity, age group, and quartile of baseline FS scores. Results. The results showed that MCII was dependent on patient baseline and demographic characteristics. Patients who were male, were younger, had more-acute symptoms, or had lower FS scores at admission required more FS change to report meaningful change. Limitations. As this study was a secondary analysis, how the length of treatment mediated the relationship between the independent and dependent variables was unclear. Conclusions. Although a single MCII index may provide a standard cut-score defining the smallest FS change that is meaningful to patients, researchers and clinicians should be aware that MCII is context specific and not a fixed attribute. Current results may help researchers, clinicians, and policy makers to interpret FS change related to the importance of the change to the patient. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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