期刊
JOURNAL OF CLINICAL EPIDEMIOLOGY
卷 64, 期 5, 页码 487-496出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2010.07.012
关键词
MCID; Sensitivity and specificity; Psychometric properties; Reproducibility of results; Health status indicators; Responder analyses
资金
- College of Physiotherapists of Ontario
- Institute for Work Health
- Canadian Institutes of Health Research (CIHR)
- NSERC
Objective: The pursuit of interpretability of longitudinal measures of patient outcome has led to several methods for defining minimal amounts of change or final states that are important. Little is known about the best method. The purpose of this study was to directly compare methods using diagnostic utility to evaluate their usefulness. Study Design and Setting: Secondary analysis of longitudinal cohort data of persons attending physiotherapy for shoulder pain. Disability of the arm, shoulder, and hand outcome fielded at baseline and 3 months. Published methods were used to define positive response in scores: minimal change, final state, and combined change and final state. Proportions described as improved were compared (Kappa) and diagnostic testing techniques used to evaluate the strengths of each. Results: Only moderate agreement was found between methods (Kappa = 0.47). Minimal clinically important differences were most sensitive but not specific. Final states were less sensitive, more specific, and most accurate. Combinations were slightly less specific. Conclusion: A new approach allowed us to evaluate the relative merits and risks of different approaches to interpreting longitudinal patient outcomes. Our study points to a combination of change greater than error and/or a final score within general population norms as being the most clinically sensible with strong diagnostic accuracy. (C) 2011 Elsevier Inc. All rights reserved.
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