Minimal clinically important difference and minimal detectable change of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) amongst patients with chronic musculoskeletal pain

Abstract

Objectives: The aim of this study is to estimate a minimal clinically important difference (MCID) and a minimal detectable change (MDC) of the 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. Design: Cross-sectional cohort study. Setting: Outpatient Physical and Rehabilitation Medicine clinic. Subjects: A total of 1988 consecutive patients with musculoskeletal pain. Interventions: A distribution-based approach was employed to estimate a minimal clinically important difference, a minimal detectable change, and a minimal detectable percent change (MDC%). Results: The mean age of the patients was 48 years, and 65% were women. The average intensity of pain was 6,3 (2.0) points (0–10 numeric rating scale) and the mean WHODAS 2.0 total score was 13 (9) points out of 48. The minimal clinically important difference ranged between 3.1 and 4.7 points. The minimal detectable change was 8.6 points and minimal detectable % change was unacceptably high 66%. Conclusions: Amongst patients with chronic musculoskeletal pain, the 12-item WHODAS 2.0 demonstrated a high minimal detectable change of almost nine points. As the minimal detectable change exceeded the level of minimal clinically important difference, nine points were considered to be the amount of change perceived by a respondent as clinically significant.

Why science is less scientific than we think (and what to do about it): The 2022 Gaston Labat Award Lecture

“…Patients who rated their improvement as ‘much better’ can be combined, and the difference between their preintervention and postintervention scores define a ‘benchmark’ of what improvement is deemed clinically important to each individual . The MCID can be significantly influenced by a myriad of patient characteristics such as age,7 gender,8 body mass index,7 culture,9 ethnicity,10 geographic locality,9 educational level,11 perceived general health,11 disease status,12 and socioeconomic status; intervention tolerability, adverse effects, and safety; as well as pain baseline,8 duration, intensity, frequency, location, etiology… well, you get the picture 13. As just one simplistic example, a small benefit from a treatment that is well tolerated and safe will usually be considered more acceptable than a larger benefit from a treatment that kills 50% of patients.…”

A Multidimensional Virtual Reality Neurorehabilitation Approach to Improve Functional Memory: Who Is the Ideal Candidate?

“…For each outcome measure, changes scores (Δ change) from T1 to T0 were calculated. Minimal Clinical Important Difference (MCID) was derived separately for each pathology computing one-half of the deviation standard, according to Katajapuu et al ( 44 ) and Shikiar et al ( 45 ). After that, each change score was categorized into one of three categories: positive effect of the treatment (Δ change > MCID), stable after treatment (–MCID ≤ Δ change ≤ MCID), and no effect of the treatment (Δ change < MCID).…”

Efeito de um protocolo de exercícios para fortalecimento da musculatura cervical em migranosos em comparação ao grupo placebo - ensaio clínico randomizado

“…Relevância clínica é definida como "valor prático, aplicável ou importante do efeito de uma intervenção" (KAZDIN, 1999) e pode ser calculada pelos métodos de distribuição ou de âncoras. Nos métodos de distribuição, os cálculos podem ser facialmente feitos com base nos resultados do estudo, ou seja, a relevância clínica é baseada explicitamente na variabilidade estatística dos valores obtidos (ARMIJO-OLIVO et al, 2021;KATAJAPUU et al, 2020). De acordo com a literatura, os mais comuns métodos de distribuição são o TE, o erro da medida, o desvio padrão, a média de resposta padronizada e a mínima mudança detectável (MOUELHI et al, 2020).…”

“…De acordo com a literatura, os mais comuns métodos de distribuição são o TE, o erro da medida, o desvio padrão, a média de resposta padronizada e a mínima mudança detectável (MOUELHI et al, 2020). Por outro lado, o método de âncoras incorpora o ponto de vista de diversas partes interessadas, como por exemplo o ponto de vista do paciente (ARMIJO-OLIVO et al, 2021;KATAJAPUU et al, 2020).…”

“…Ambos os métodos apresentam vantagens e desvantagens e até o momento, não há na literatura um consenso sobre qual método é preferível (KATAJAPUU et al, 2020). Dentre as vantagens dos métodos de distribuição pode-se destacar sua fácil aplicabilidade e entendimento.…”