Minimum clinically important differences in chronic pain vary considerably by baseline pain and methodological factors: systematic review of empirical studies

Olsen, Mette Frahm; Bjerre, Eik Dybboe; Hansen, Maria Damkjær; Tendal, Britta; Hilden, Jørgen; Hróbjartsson, Asbjørn

doi:10.1016/j.jclinepi.2018.05.007

Cited by 180 publications

(134 citation statements)

References 92 publications

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“…65,66 , A recent review confirms that 30% improvement in pain represents clinically important change. 67 Secondary outcomes included pain severity on the BPI and quality of life measured by the 10-item Patient-Reported Outcomes Measurement Information Systems (PROMIS-10) global health measure, which includes ratings of physical function and emotional distress. 64,68 We tracked use of opiate medications using two methods.…”

Section: Outcomes and Follow-upmentioning

confidence: 99%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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Background Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. Objective Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. Design This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. Participants Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. Interventions Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. Main Measures Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. Key Results 37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI − 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI − 4.2%, 11.4%). Conclusions Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. Trial Registration Clinicaltrials.gov # NCT02456727

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Section: Outcomes and Follow-upmentioning

confidence: 99%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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“…This was only true in the Danish cohort of the present study and for the cut-off-level of large improvements, making the interpretability of small changes of individual scores of the MSK-HQ more challenging. As MCIC estimates based on relative scores were unaffected by the cut-off level of the transition question and relative scores have shown to be less sensitive to baseline scores [30]; the MCIC percent seems the preferable choice. However, both absolute and relative MCIC values varied between the two cohorts.…”

Section: Sensitivity To Change Responsiveness and Interpretabilitymentioning

confidence: 96%

“…Minimal clinically important change (MCIC) values were estimated by the Pythagoras' Theorem (a^2 + b^2 = c^2) to choose the change score closest to the upper left-hand corner, which best discriminated between improved and unchanged patients [29]. As MCIC values can be affected by baseline scores, analysis was repeated with relative change scores (i.e., change scores expressed as percentages of the baseline scores) [30]. Finally, differences in area under the ROC curve between MSK-HQ and the EQ-5D change scores were tested [31].…”

Section: Sensitivity To Change Responsiveness and Interpretabilitymentioning

confidence: 99%

Measurement properties of the Musculoskeletal Health Questionnaire (MSK-HQ): a between country comparison

Christiansen¹,

McCray

Winding

et al. 2019

Preprint

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Background The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages. Objective The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain. Methods MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n=153) and UK (n=166) cohorts. Results The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients’ own judgment at 3 months exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8-10 points and 26% for the DK cohort and 6-8 points and 29% for the UK cohort. Conclusions The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.

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“…Den systematiske oversikten viste også hvilken e ekt musikk har på forskjellige smertetyper, og fant at musikk reduserer smerteintensiteten i størst grad for vedvarende ikke-maligne smerter og fødselssmerter. Begge smertetypene ble redusert med en e ekt som viste seg å vaere klinisk stor og relevant i favør av musikk (25,26).…”

Section: «Selv Om Det Er Viktig å Kartlegge Smerte Vil Ikke Det I Seunclassified

Sykepleiere er avgjørende for god smertebehandling

Sandvik¹,

Rustøen²

2020

Sykepleien

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Minimum clinically important differences in chronic pain vary considerably by baseline pain and methodological factors: systematic review of empirical studies

Cited by 180 publications

References 92 publications

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Measurement properties of the Musculoskeletal Health Questionnaire (MSK-HQ): a between country comparison

Sykepleiere er avgjørende for god smertebehandling

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