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Published on: August 4, 2022
Minimal Clinically Important Difference of Vestibular Migraine Patient Assessment Tool and Handicap Inventory
Adam Gardi1, Maxwell Hum1, Daniel Wong1
1Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA.
Objective:
To calculate the minimal clinically important difference (MCID) for the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).
Study Design:
Prospective cohort study.
Setting:
A single tertiary care balance and falls center.
Methods:
Fifty-three subjects meeting Barany Society criteria for vestibular migraine (VM) or probable VM were included and divided into 3 treatment groups. Treatment was not standardized, instead, management was decided individually between each patient and their provider. All subjects completed VM-PATHI before and after intervention. A Global Rating of Change (GRoC) questionnaire was also completed following intervention. Anchor-based methods, using a GRoC questionnaire, were utilized to estimate the MCID that produced the highest sensitivity and specificity on a receiver operating characteristic (ROC) curve.
Results:
Forty-three subjects were classified as responders and 10 were classified as nonresponders. The mean VM-PATHI pretreatment score minus the posttreatment score between the responders (mean = 14, SD 13) and nonresponders (mean = 4 SD = 12) was statistically significant (mean difference = 10, 95% confidence interval, CI [1, 20], P = .03). The VM-PATHI score change cutoff that best differentiated between responders and nonresponders was a VM-PATHI change of 6. Thus, the MCID was defined as a change of 6 points (sensitivity = 72%, specificity = 70%). The area under the ROC curve was 0.89, 95% CI [0.80, 0.98], which demonstrates an excellent ability for the VM-PATHI score change to discriminate between responders and nonresponders. The average change in VM-PATHI scores was 9 points (SD 11) for those with "a little better" rating on the GRoC, 14 points (SD 14) for those with a "moderately better" rating, and 20 points (SD 13) for those with a "very much better" rating.
Conclusion:
Patients with VM are likely to demonstrate clinical improvement if their VM-PATHI score decreases by 6 or more.
Insights
A change of 6 points or more on the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) indicates meaningful improvement for vestibular migraine patients. This finding helps interpret treatment outcomes and assess clinical significance.
Area of Science:
- Neurology
- Audiology
- Otolaryngology
Background:
- Vestibular migraine (VM) is a debilitating condition affecting balance and quality of life.
- Quantifying clinical improvement in VM requires validated patient-reported outcome measures.
- The Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) is used to assess VM impact.
Purpose of the Study:
- To determine the minimal clinically important difference (MCID) for the VM-PATHI.
- Establish a threshold score change on the VM-PATHI that signifies a clinically relevant improvement for patients with VM.
Main Methods:
- A prospective cohort study was conducted at a single tertiary care balance and falls center.
- Fifty-three subjects with VM or probable VM completed the VM-PATHI before and after intervention.
- Anchor-based methods using a Global Rating of Change (GRoC) questionnaire were employed to calculate the MCID via ROC curve analysis.
Main Results:
- Forty-three subjects (79%) were classified as responders.
- A VM-PATHI score change of 6 points demonstrated the best discrimination between responders and nonresponders (sensitivity 72%, specificity 70%).
- The MCID for the VM-PATHI was established as a 6-point decrease, with excellent discriminative ability (AUC = 0.89).
Conclusions:
- A decrease of 6 or more points on the VM-PATHI suggests a clinically meaningful improvement in patients with vestibular migraine.
- This MCID value provides a reliable benchmark for interpreting treatment effectiveness in VM clinical trials and practice.
