Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures

Abstract

We define the minimal important change (MIC) as a threshold for a minimal within-person change over time above which patients perceive themselves importantly changed. There is a lot of confusion about the concept of MIC, particularly about the concepts of minimal important change and minimal detectable change, which questions the validity of published MIC values. The aims of this study were: (1) to clarify the concept of MIC and how to use it; (2) to provide practical guidance for estimating methodologically sound MIC values; and (3) to improve the applicability of PROMIS by summarizing the available evidence on plausible PROMIS MIC values. We discuss the concept of MIC and how to use it and provide practical guidance for estimating MIC values. In addition, we performed a systematic review in PubMed on MIC values of any PROMIS measure from studies using recommended approaches. A total of 50 studies estimated the MIC of a PROMIS measure, of which 19 studies used less appropriate methods. MIC values of the remaining 31 studies ranged from 0.1 to 12.7 T-score points. We recommend to use the predictive modeling method, possibly supplemented with the vignette-based method, in future MIC studies. We consider a MIC value of 2–6 T-score points for PROMIS measures reasonable to assume at this point. For surgical interventions a higher MIC value might be appropriate. We recommend more high-quality studies estimating MIC values for PROMIS.

Acute relationships between mental health and cognitive function during the COVID-19 pandemic: Longitudinal evidence from middle-aged and older US adults

“…Cognitive outcomes were assessed with the 6-item Patient Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function and Abilities scales ( HealthMeasures, 2019 ). The Cognitive Function scale captures negative sentiments about cognition, while the Cognitive Abilities scale captures positive sentiments about cognition, both as applied to scenarios of daily life ( HealthMeasures, 2019 ; Terwee et al, 2021 ). Both scales give a series of statements about cognitive function or abilities in the past 7 days, with statements such as “My thinking has been slow” and “I have had trouble concentrating” (Cognitive Function scale), and “My mind has been as sharp as usual” and “My memory has been as good as usual” (Cognitive Abilities scale).…”

Substantial clinical benefit and patient acceptable symptom states of the Forgotten Joint Score 12 after primary knee arthroplasty

“…A credible anchor is well defined and relevant to the driven hypothesis such as the presence of specific symptoms, disease activity, or ratings of change ( 12 ). Obviously, it should correlate well with the PROM of interest and be comprehensible ( 9 , 12 ). It is important to emphasize that, depending on hypothesis, the anchor questions can be either patient- or clinician-rated, although the former is preferred to assure patient perspective ( 12 ).…”

“…To our knowledge, there is no previous assessment of the SCB with the predictive approach but instead most commonly ROC curve based approaches. The last few years the predictive approach has been used more frequently for assessment of MIC values and is now one of the recommended statistical strategies in that area ( 9 ). SCB and MIC values are fundamentally different as they represent distinctly different markers on the outcome span.…”

“…Estimations such as SCB, MIC, and PASS are used to interpret data in research and, at least in theory, to aid shared decision-making prior to treatments or interventions ( 9 ). Previously assessed meaningful values of the FJS vary broadly between studies due to differences in the study cohorts and perhaps due to variations in healthcare systems and cultural contexts.…”

“…The results were presented with 95% confidence interval (CI) obtained by bootstrapping (2,000 samples). We used the R syntax provided by Terwee et al ( 9 ) for the analyses of meaningful values. The statistical analyses were performed with SPSS Statistics 27.0 (IBM Corp, Armonk, NY, USA) and R version 3.6.2 (R Foundation for Statistical Computing, Vienna, Austria; https://www.R-project.org/ ).…”