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E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

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The relation between the minimally important difference and patient benefit.

Geoffrey R Norman¹

¹Program for Educational Research and Development, McMaster University, Building T-13, Hamilton, Ontario, Canada. norman@mcmaster.ca

|December 2, 2006

Summary

The effect size of a treatment reliably predicts patient benefit, independent of the Minimally Important Difference (MID) threshold. This finding suggests effect size is a more robust measure for assessing treatment efficacy in clinical practice.

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Published on: August 1, 2019

Area of Science:

Health Services Research
Clinical Epidemiology
Biostatistics

Background:

Determining clinical relevance of treatment effects on quality of life is crucial.
The anchor-based method, using Minimally Important Difference (MID), is a common approach.
The utility of MID in differentiating treatment benefits is questioned.

Purpose of the Study:

To investigate the relationship between treatment effect size (ES), MID, and the likelihood of patient benefit.
To assess if MID is a meaningful criterion for treatment efficacy.

Main Methods:

A simulation study using normal distributions to model patient benefit.
Calculated the proportion of benefiting patients for various ES and MID values.
Validated simulation results against empirical data from four respiratory disease studies.

Main Results:

A near-linear relationship was observed between ES and the likelihood of patient benefit.
This relationship was largely independent of the chosen MID value.
Simulation results showed excellent agreement with empirical data, even with moderate distribution skew.

Conclusions:

The proportion of patients benefiting from treatment can be accurately estimated from the effect size alone.
Effect size and anchor-based approaches provide equivalent information regarding treatment benefit.
The concept of MID as an absolute indicator of clinically important effects has limited utility.