Measures of Clinical Meaningfulness and Important Differences

Physical Therapy
John P Collins

Abstract

Measures of clinical significance have been in use for several decades as a means of interpreting clinical findings and patient-reported outcomes. The most common of these measures is the minimal clinically important difference. With the rise in popularity of measurements of clinical significance, several common misconceptions have arisen that may impact their interpretation and application to clinical practice. The purpose of this article is to present a schema for understanding measurement of clinical significance and use this to highlight the reasons why misuse and misinterpretation have occurred. A new measure of clinical significance is then defined that is intended to be resistant to these issues. Clinical significance has long been a topic of importance to researchers looking to make their findings interpretable and has been quantified in diverse ways.1 Recently, there has been rapidly increasing interest in and use of an assortment of minimal (clinically) important difference measures. The range of their use is illustrated by the publications of reviews and meta-analyses in pain relief,2 cognitive interventions for dementia,3 and CT densitometry for patients with chronic obstructive pulmonary disease.4 Consensus has not...Continue Reading

References

Dec 1, 1989·Controlled Clinical Trials·R JaeschkeG H Guyatt
Apr 1, 1997·American Journal of Respiratory and Critical Care Medicine·D A RedelmeierG H Guyatt
Jun 16, 1999·Journal of Consulting and Clinical Psychology·A E Kazdin
Apr 22, 2005·British Journal of Clinical Pharmacology·J K Aronson
Apr 17, 2009·The Journal of Rheumatology·Robert M BennettAlesia B Sadosky
Apr 12, 2011·Expert Review of Pharmacoeconomics & Outcomes Research·Madeleine T King
Dec 25, 2012·American Journal of Respiratory and Critical Care Medicine·Michael I PolkeyUNKNOWN Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study Investigators

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