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The minimal clinically important difference determined using item response theory models: an attempt to solve the
Alexandra Rouquette1, Myriam Blanchin2, Véronique Sébille2
1U669 -Mental Health and Public Health, Inserm, Maison de Solenn, 97 boulevard du Port-Royal, 75014 Paris, France; UMR-S0669, Université Paris-Sud and Université Paris Descartes, Maison de Solenn, 97 boulevard du Port-Royal, 75014 Paris, France; Research Unit on Children's Psychosocial Maladjustment, University of Montreal, 3050 Édouard Montpetit, H3T 1J7, Montreal, Quebec, Canada; EA 4275, Biostatistics, Clinical Research and Subjective Measures in Health Sciences, University of Nantes, Faculté de Médecine & Pharmacie, 1, rue Gaston Veil - BP 53508, 44035 Nantes Cedex 1, France; Department of Public Health, University of Angers, CHU Angers- 49933 Angers cedex 9, France.
Objectives:
Determining the minimal clinically important difference (MCID) of questionnaires on an interval scale, the trait level (TL) scale, using item response theory (IRT) models could overcome its association with baseline severity. The aim of this study was to compare the sensitivity (Se), specificity (Sp), and predictive values (PVs) of the MCID determined on the score scale (MCID-Sc) or the TL scale (MCID-TL).
Study Design And Setting:
The MCID-Sc and MCID-TL of the MOS-SF36 general health subscale were determined for deterioration and improvement on a cohort of 1,170 patients using an anchor-based method and a partial credit model. The Se, Sp, and PV were calculated using the global rating of change (the anchor) as the gold standard test.
Results:
The MCID-Sc magnitude was smaller for improvement (1.58 points) than for deterioration (-7.91 points). The Se, Sp, and PV were similar for MCID-Sc and MCID-TL in both cases. However, if the MCID was defined on the score scale as a function of a range of baseline scores, its Se, Sp, and PV were consistently higher.
Conclusion:
This study reinforces the recommendations concerning the use of an MCID-Sc defined as a function of a range of baseline scores.
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