Identification of clinically important changes in health status using receiver operating characteristic curves

Ward, Michael M.; Marx, A S; Barry, Nouhoun

doi:10.1016/s0895-4356(99)00140-7

Cited by 37 publications

(27 citation statements)

References 11 publications

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“…The area under the curve (AUC) and 95% confidence interval (CI) were calcu- 43 If the lower limit of the AUC 95% CI was Ͼ0.5, the relationship between change in CGS and mRS was considered sufficient to estimate the MCID for CGS. Identifying a sufficient relationship between the 2 variables was the primary purpose of the ROC curve.…”

Section: Estimation Of Mcidmentioning

confidence: 99%

Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

et al. 2010

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We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s. Patients with subacute stroke who increase gait speed >or=0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not. Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke.

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Section: Estimation Of Mcidmentioning

confidence: 99%

Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

et al. 2010

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“…The first is measured through self-report and aligns itself to measuring what counts, that is, at what ICF level of activity does this person attain community ambulation and with what assistance? Although there is empirical evidence to support the advantages of self-reported measures mostly because of their superior content validity (eg, the Patient Generated Index 39 the Patient-Specific Measure 40 ), this approach may be limited because of the difficulties in determining criteria for clinically important change in a heterogenous group of patients, the judgments of whom regarding change are neither necessarily congruent nor consistent over time 41 Comparisons of outcomes across studies, therefore, can become problematic. 42 Perhaps more importantly, outcome comparisons do not help the tester identify which aspects of the task the person finds difficult to master and identify those people who may attain community ambulation; the comparisons, therefore, are less able to inform the rehabilitation process.…”

Section: What Might a Relevant Measure For Community Ambulation Look mentioning

confidence: 99%

Measurement of Community Ambulation After Stroke

Lord

Rochester

2005

Stroke

194

151

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Background and Purpose-This report considers the measurement of community ambulation for people with stroke. The conceptual issues underlying measurement of community ambulation are reviewed, and tests that measure either the task itself or at least some of its components are identified and discussed. Conclusions-The findings from this review suggest that although some progress has been made toward identifying community ambulation as a stand-alone entity, reliable and valid measures have not yet been developed. Gait speed, which is used often as a proxy measure for community ambulation, does not consistently reflect the level of community ambulation attained, and continued reliance on its use, particularly the 10-m timed walk, is misplaced. The limitations of the measures reviewed here point toward self-report as being the most useful outcome for current clinical use. However, this report highlights the need for research to first inform a theoretical framework for the measurement of community ambulation, from which a measurement tool or a battery of measurements can be developed and tested.

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“…The optimal cut point on the target measure is the one with the least number of misclassifications compared with the anchor measure. Misclassifications are false-positives (respondents mistakenly classified as experiencing a change) and false-negatives (respondents mistakenly classified as not experiencing a change) [50,53]. Changes in scores on instruments measuring dyspnea, fatigue, and emotional function in patients with chronic heart and lung disease calibrated against patient global ratings of change have found that a mean score change of 0.5 on a 7-point Likert scale corresponds to the MCID [46].…”

Section: Interpretability Of Rating Scalesmentioning

confidence: 99%

The Spectrum of Functional Rating Scales in Neurology Clinical Trials

Narayanaswami

2017

Neurotherapeutics

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The selection of an appropriate outcome measure is crucial to the success of a clinical trial, in order to obtain accurate results, which, in turn, influence patient care and future research. Outcomes that can be directly measured are mortality/survival. More frequently, neurology clinical trials evaluate outcomes that cannot be directly measured, such as disability, cognitive function, or change in symptoms of the condition under study. These complex outcomes are abstract ideas or latent constructs and are measured using rating scales. Functional rating scales typically assess the ability of patients to perform tasks and roles for everyday life. Rating scales should be valid (measure what they are supposed to measure), reliable (provide similar results if administered under the same conditions), and responsive (able to detect clinically important changes over time). The clinical relevance of rating scales depends on their ability to detect a minimal clinically important difference, and should be distinguished from statistical significance. Most rating scales are ordinal scales and have limitations. Modern psychometric methods of Rasch analysis and item response theory, termed latent trait theory, are increasingly being utilized to convert ordinal data to interval measurements, both to validate existing scales and to develop new scales. Patient-reported outcomes are being increasingly used in clinical trials and have a role in clinical quality assessment. The PROMIS and NeuroQoL databases are excellent resources for rigorously developed and validated patientreported outcomes.

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Identification of clinically important changes in health status using receiver operating characteristic curves

Cited by 37 publications

References 11 publications

Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

Measurement of Community Ambulation After Stroke

The Spectrum of Functional Rating Scales in Neurology Clinical Trials

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