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Determining the Minimal Clinical Important Difference for Medication Quantification Scale III and Morphine Milligram
Lisa Goudman1,2,3,4, Ann De Smedt2,3,5, Patrice Forget6
1Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium.
Abstract:
The Medication Quantification Scale III (MQS) is a tool to represent the negative impact of medication. A reduction in medication can serve as an indicator to evaluate treatment success. However, no cut-off value has yet been determined to evaluate whether a decrease in medication is clinically relevant. Therefore, the objective is to estimate the thresholds for the MQS and morphine milligram equivalents (MMEs) that best identify a clinically relevant important improvement for patients. Data from the Discover registry, in which patients with failed back surgery syndrome were treated with high-dose spinal cord stimulation, were used. Patient satisfaction was utilized to evaluate a clinically important outcome 12 months after stimulation. Anchor-based and distribution-based methods were applied to determine the minimal clinical important difference (MCID). Distribution-based methods revealed a value of 4.28 for the MQS and 33.61 for the MME as MCID. Anchor-based methods indicated a percentage change score of 41.2% for the MQS and 28.2% for the MME or an absolute change score of 4.72 for the MQS and 22.65 for the MME. For assessing a treatment outcome, we recommend using the percentage change score, which better reflects a clinically important outcome and is not severely influenced by high medication intake at baseline.
Insights
Researchers estimated thresholds for the Medication Quantification Scale III (MQS) and morphine milligram equivalents (MMEs) to determine clinically relevant treatment improvements. Percentage change scores are recommended for evaluating outcomes in patients with failed back surgery syndrome.
Area of Science:
- Pain Management
- Clinical Outcomes Research
Background:
- The Medication Quantification Scale III (MQS) quantifies medication's negative impact.
- Assessing treatment success often involves medication reduction, but clinical relevance thresholds are undefined.
- Establishing minimal clinically important difference (MCID) for MQS and MMEs is crucial for outcome evaluation.
Purpose of the Study:
- To estimate MCID thresholds for MQS and morphine milligram equivalents (MMEs).
- To identify values indicating a clinically relevant improvement in patients undergoing spinal cord stimulation for failed back surgery syndrome.
Main Methods:
- Utilized data from the Discover registry for patients with failed back surgery syndrome treated with spinal cord stimulation.
- Employed anchor-based and distribution-based methods to determine MCID.
- Assessed patient satisfaction at 12 months as the primary outcome measure.
Main Results:
- Distribution-based methods suggested MCID values of 4.28 for MQS and 33.61 for MME.
- Anchor-based methods indicated percentage change scores of 41.2% (MQS) and 28.2% (MME) or absolute change scores of 4.72 (MQS) and 22.65 (MME).
Conclusions:
- Percentage change scores for MQS and MMEs are recommended for outcome assessment.
- This approach better reflects clinically important improvements and is less affected by baseline medication levels.
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