Feeling good rather than feeling better matters more to patients

Abstract

Objective. To determine the most appropriate means to assess the response to treatment in terms of pain and functional impairment in a chronic rheumatic condition (knee osteoarthritis [OA]) and an acute rheumatic condition (rotator cuff syndrome [RCS]). Methods. Two prospective studies were conducted consisting of 1,019 outpatients with knee OA and 271 patients with acute RCS. The minimal clinically important improvement and the patient acceptable symptom state were determined for knee OA pain using a visual analog scale, and for knee OA function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale; for acute RCS pain, a numeral rating scale was used, and the Neer function subscale was used for RCS function. Results. The minimal clinically important improvement was shown to be the change required to achieve the patient acceptable symptom state, whatever the baseline level of symptom, the outcome (pain or function), or type of condition (chronic or acute). This acceptable state for pain was higher for chronic (27.0 -36.4 across the baseline score) than acute (16.7-24.1) conditions. The level of functional impairment considered satisfactory by patients with knee OA was higher for more disabled patients (43.1) than for less disabled patients (20.4). Conclusion. Patients consider that they experienced an important improvement only if this improvement allowed them to achieve a state they consider satisfactory. The most appropriate means to assess the response to therapy seems to be to assess whether patients feel good (i.e., achieve the patient acceptable symptom state).

Outcomes after total hip replacement based on patients' baseline status: What results can be expected?

“…Previous studies have reported that the MCID and PASS measure different things (12,23). Our data suggest that PASS and ROC cut points represent an upper limit of what patients can be expected to gain after THR, while the MCID represents a lower limit.…”

“…In defining these estimators more precisely, future studies should focus on the interrelationship of all these parameters. Finally, we must also note that application of the MCID and PASS parameters to clinical practice must be done cautiously (12,23,32). These reference values are for groups, not individual patients.…”

Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability

“…In recent years, groups, such as Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) have explored both MCID and defining LDAS [17,56]. Recently, this has evolved into the minimal clinically important improvement (MCII) and the PASS in the work of Tubach et al, , 2006Tubach et al, , 2009. These were not included in the current evaluation as our data collection overlapped with the publication, and we did not field the indicators needed for MCII and PASS.…”

“…This in effect validates the approach(es) as well as providing information on error and predictive values. a ''patient acceptable symptom state (PASS)'' [15,16] or similarly a ''low disease activity state (LDAS)'' [17]. Any final score better than this threshold level would be a positive or satisfactory outcome statedregardless of the change it took to get there.…”

Good, or Just Better?

“…They are appreciative if we can help them feel better, but ideally they don't just want to feel better, they want to feel good. 7,14,16 If possible, they probably want to feel as funkadelicly good as James Brown seemed to feel onstage. Numerous patient-reported outcome (PRO) measures have been developed to gauge the effect of our treatments on the way patients feel.…”