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Minimally clinically important difference in chronic breathlessness: every little helps
Stephen G Oxberry1, J Martin Bland, Andrew L Clark
1Kirkwood Hospice, Huddersfield, United Kingdom.
American Heart Journal
|August 11, 2012
Summary
A 1-point change on the Numerical Rating Scale (NRS) or modified Borg (mBorg) scale is a clinically meaningful improvement for chronic breathlessness in chronic heart failure (CHF). This finding helps interpret patient-reported outcomes for breathlessness in CHF.
Area of Science:
- Cardiology
- Pulmonology
- Clinical Measurement
Background:
- Breathlessness in chronic heart failure (CHF) is subjective and difficult to quantify.
- Statistically significant changes in breathlessness measures may not reflect true clinical improvement.
- This study establishes the minimally clinically important difference (MCID) for chronic breathlessness in CHF using patient-reported data.
Purpose of the Study:
- To determine the minimally clinically important difference (MCID) for breathlessness in patients with chronic heart failure (CHF).
- To establish a quantitative threshold for meaningful improvement in patient-reported breathlessness.
Main Methods:
- Utilized data from a randomized, controlled, crossover trial of morphine, oxycodone, or placebo for breathlessness in CHF.
- Assessed breathlessness intensity using 11-point Numerical Rating Scales (NRS) and modified Borg (mBorg) scales at baseline and day 4.
- Calculated the change in NRS or mBorg associated with a 1-point change in the Global impression of Change (GC) scale.
Main Results:
- Defined MCID as a 1-point change in the Global impression of Change (GC).
- Regression analysis indicated MCID for average NRS breathlessness was 0.5-2.0 U and for worst NRS was 0.4-2.9.
- MCID for average mBorg score was 0.2-2.0 and for worst mBorg score was 0.3-1.9, with all findings statistically significant (P < .001).
Conclusions:
- A 1-point change on the NRS or mBorg scale serves as a reliable estimate of MCID for average daily chronic breathlessness in CHF.
- This provides a clinically relevant benchmark for assessing treatment efficacy in managing breathlessness in CHF patients.
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