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Use of Minimal Important Difference for Patient-Reported Outcome Measures in Plastic Surgery: A Systematic Review
Ted Zhou1, Aisling Zeng1, Tal Levit1
1From the Departments of Medicine.
Background:
The minimal important difference (MID) is vital to consider when interpreting the clinical importance of observed changes from surgical interventions assessed by patient-reported outcome measures (PROMs). There is no accepted standard for how to calculate MIDs, and uptake in the plastic surgery literature is unknown, leading to methodologic and interpretation issues.
Methods:
Medline and Embase were searched to identify all plastic surgery randomized controlled trials (RCTs) using PROMs as outcomes and MID estimation studies for PROMs used by RCTs. Included studies were assessed for uptake and application of MIDs, and MID estimation methodology and values were categorized.
Results:
A total of 554 RCTs using PROMs as outcomes were identified. Of these, 419 RCTs had the possibility of incorporating a previously published MID. The uptake rate of MIDs was 11.5% ( n = 48 of 419). The most common ways MIDs were applied were to calculate sample size (37.5%) or to determine whether results were clinically important (35.4%). A total of 99 studies estimating MID values for the most common PROMs in plastic surgery, based on our review, were analyzed. The most common estimation methodologies were receiver operating characteristic curve analysis (49%), change difference (31%), and SD (25%).
Conclusions:
This review highlights limited uptake and application of MIDs in plastic surgery. The authors propose 4 major barriers: (1) no repository of published MIDs for PROMs used in plastic surgery exists; (2) available MIDs are not specific to plastic surgery populations; (3) high heterogeneity in MID estimation methodology was present; and (4) there are wide ranges in MID values, with no superior choice identified.
Insights
Minimal important difference (MID) use in plastic surgery is low, with inconsistent methods and values. This limits interpretation of patient-reported outcomes (PROMs) in surgical trials.
Area of Science:
- Plastic Surgery
- Patient-Reported Outcome Measures (PROMs)
- Clinical Trial Methodology
Background:
- Minimal important difference (MID) is crucial for interpreting clinical significance of surgical outcomes measured by PROMs.
- Lack of standardized MID calculation methods and unknown uptake in plastic surgery create interpretation challenges.
Purpose of the Study:
- To assess the uptake and application of MIDs in plastic surgery randomized controlled trials (RCTs).
- To analyze MID estimation methodologies and values for PROMs commonly used in plastic surgery.
Main Methods:
- Systematic literature search of Medline and Embase for plastic surgery RCTs using PROMs.
- Included studies were evaluated for MID incorporation and application.
- MID estimation studies for relevant PROMs were analyzed for methodology and reported values.
Main Results:
- 11.5% of eligible RCTs (48/419) utilized MIDs, primarily for sample size calculation or determining clinical importance.
- 99 studies estimating MIDs for common plastic surgery PROMs were analyzed.
- Receiver operating characteristic curve analysis (49%), change difference (31%), and SD (25%) were the most frequent estimation methods.
Conclusions:
- Limited uptake and inconsistent application of MIDs in plastic surgery were observed.
- Barriers include lack of a central MID repository, non-specific MID values for plastic surgery populations, methodological heterogeneity, and wide value ranges.
