Abstract
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.
Keywords
List of abbreviations:
GIC (Global Impression of Change), MCID (minimal clinically important difference), RCI (Reliable Change Index), RCID (robust clinically important difference), ROC (receiver operating characteristic), SEM (standard error of measurement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 14, 2020
Footnotes
Supported in part by the National Institute on Disability, Independent Living, and Rehabilitation Research–Traumatic Brain Injury National Data and Statistical Center (grant no. 90DP0084).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
