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Published on: May 2, 2019
Minimally important change determined by a visual method integrating an anchor-based and a distribution-based
Henrica C W de Vet1, Raymond W J G Ostelo, Caroline B Terwee
1EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. hcw.devet@vuc.nl
Summary
This study introduces a visual anchor-based method to determine minimally important change (MIC) in health status scores. The approach integrates distribution-based and anchor-based methods for better interpretation of patient outcomes.
Area of Science:
- Health Outcomes Research
- Clinical Measurement
- Patient-Reported Outcomes
Background:
- Minimally important change (MIC) is crucial for interpreting health status instrument results.
- Existing methods for assessing MIC include distribution-based and anchor-based approaches.
- A unified method is needed to integrate these approaches for robust interpretation.
Purpose of the Study:
- To describe and apply a novel visual method, the anchor-based MIC distribution method.
- This method integrates both distribution-based and anchor-based approaches to MIC assessment.
- To illustrate the application of this method for the Pain Intensity Numerical Rating Scale in low back pain patients.
Main Methods:
- Patients are categorized based on an anchor into groups: important improvement, important deterioration, or no important change.
- The distribution of change scores from a health status instrument is visualized in a graph for these patient groups.
- Two cut-off points for MIC are presented: the ROC cut-off and the 95% limit cut-off.
Main Results:
- The anchor-based MIC distribution method was illustrated using the Pain Intensity Numerical Rating Scale for low back pain.
- The method visually represents score distributions across anchor-defined patient categories.
- The impact of selecting either the ROC cut-off or 95% limit cut-off on MIC determination is shown.
Conclusions:
- The anchor-based MIC distribution method offers a versatile framework applicable to various anchors.
- It necessitates explicit selection and justification of anchors and their minimal importance definitions.
- MIC is context-dependent, influenced by perspective and baseline values, requiring a balance between single values and ranges.
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