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Wang Y, Devji T, Qasim A, Hao Q, Wong V, Bhatt M, Prasad M, Wang Y, Noori A, Xiao Y, Ghadimi M, Lozano LEC, Phillips MR, Carrasco-Labra A, King M, Terluin B, Terwee C, Walsh M, Furukawa TA, Guyatt GH. A systematic survey identified methodological issues in studies estimating anchor-based minimal important differences in patient-reported outcomes. J Clin Epidemiol 2021; 142:144-151. [PMID: 34752937 DOI: 10.1016/j.jclinepi.2021.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To systematically survey the literature addressing the reporting of studies estimating anchor-based minimal important differences (MIDs) and choice of optimal MIDs. STUDY DESIGN AND SETTING We searched Medline, Embase and PsycINFO from 1987 to March 2020. Teams of two reviewers independently identified eligible publications and extracted quotations addressing relevant issues for reporting and/or selecting anchor-based MIDs. Using a coding list, we assigned the same code to quotations capturing similar or related issues. For each code, we generated an 'item', i.e. a specific phrase or sentence capturing the underlying concept. When multiple concepts existed under a single code, the team created multiple items for that code. We clustered codes addressing a broader methodological issue into a 'category' and classified items as relevant for reporting, relevant for selecting an anchor-based MID, or both. RESULTS We identified 136 eligible publications that provided 6 categories (MID definition, anchors, patient-reported outcome measures, generalizability and statistics) and 24 codes. These codes contained 34 items related to reporting MID studies, of which 29 were also related to selecting MIDs. CONCLUSION The systematic survey identified items related to reporting of anchor-based MID studies and selecting optimal MIDs. These provide a conceptual framework to inform the design of studies related to MIDs, and a basis for developing a reporting standard and a selection approach for MIDs.
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Affiliation(s)
- Yuting Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Tahira Devji
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Anila Qasim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Qiukui Hao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Guoxuexiang 37#, Chengdu, China.
| | - Vanessa Wong
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Manya Prasad
- Department of Clinical research, Epidemiology and Biostatistics, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India-110070.
| | - Ying Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Atefeh Noori
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8; West China School of Nursing / Department of Nursing, West China Hospital, Sichuan University, Guoxuexiang 37#, Chengdu, China.
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Luis Enrique Colunga Lozano
- Department of clinical medicine, School of Medicine, Universidad de Guadalajara, El Retiro, 44280, Guadalajara, Jal. México.
| | - Mark R Phillips
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Alonso Carrasco-Labra
- Department of Oral and Craniofacial Health Science, School of Dentistry, University of North Carolina at Chapel Hill, 385 S Columbia St, Chapel Hill, NC, 27599, United States.
| | - Madeleine King
- Sydney Quality of Life Office, School of Psychology, University of Sydney, Griffith Taylor Building (A19), The University of Sydney, NSW 2006, Australia.
| | - Berend Terluin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health research institute, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Caroline Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health research institute, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Michael Walsh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8; Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8; Population Health Research Institute, Hamilton Health Sciences /McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501 Japan.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 1280 Main St East, Hamilton, Canada, L8S 4L8.
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Abstract
PurposeDecision-making is always an issue that managers have to deal with. Keenly observing to different preferences of the targets provides useful information for decision-makers who do not require too much information to make decisions. The main purpose is to avoid decision-makers in a dilemma because of too much or opaque information. Based on problem-oriented, this research aims to help decision-makers to develop a macro-vision strategy that fits the needs of different clusters of customers in terms of their favorite restaurants. This research also focuses on providing the rules to rank data sets for decision-makers to make choices for their favorite restaurant.Design/methodology/approachWhen the decision-makers need to rethink a new strategic planning, they have to think about whether they want to retain or rebuild their relationship with the old consumers or continue to care for new customers. Furthermore, many of the lecturers show that the relative concept will be more effective than the absolute one. Therefore, based on rough set theory, this research proposes an algorithm of related concepts and sends questionnaires to verify the efficiency of the algorithm.FindingsBy feeding the relative order of calculating the ranking rules, we find that it will be more efficient to deal with the faced problems.Originality/valueThe algorithm proposed in this research is applied to the ranking data of food. This research proves that the algorithm is practical and has the potential to reveal important patterns in the data set.
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Cook JA, Julious SA, Sones W, Hampson LV, Hewitt C, Berlin JA, Ashby D, Emsley R, Fergusson DA, Walters SJ, Wilson EC, MacLennan G, Stallard N, Rothwell JC, Bland M, Brown L, Ramsay CR, Cook A, Armstrong D, Altman D, Vale LD. Practical help for specifying the target difference in sample size calculations for RCTs: the DELTA 2 five-stage study, including a workshop. Health Technol Assess 2019; 23:1-88. [PMID: 31661431 PMCID: PMC6843113 DOI: 10.3310/hta23600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The randomised controlled trial is widely considered to be the gold standard study for comparing the effectiveness of health interventions. Central to its design is a calculation of the number of participants needed (the sample size) for the trial. The sample size is typically calculated by specifying the magnitude of the difference in the primary outcome between the intervention effects for the population of interest. This difference is called the 'target difference' and should be appropriate for the principal estimand of interest and determined by the primary aim of the study. The target difference between treatments should be considered realistic and/or important by one or more key stakeholder groups. OBJECTIVE The objective of the report is to provide practical help on the choice of target difference used in the sample size calculation for a randomised controlled trial for researchers and funder representatives. METHODS The Difference ELicitation in TriAls2 (DELTA2) recommendations and advice were developed through a five-stage process, which included two literature reviews of existing funder guidance and recent methodological literature; a Delphi process to engage with a wider group of stakeholders; a 2-day workshop; and finalising the core document. RESULTS Advice is provided for definitive trials (Phase III/IV studies). Methods for choosing the target difference are reviewed. To aid those new to the topic, and to encourage better practice, 10 recommendations are made regarding choosing the target difference and undertaking a sample size calculation. Recommended reporting items for trial proposal, protocols and results papers under the conventional approach are also provided. Case studies reflecting different trial designs and covering different conditions are provided. Alternative trial designs and methods for choosing the sample size are also briefly considered. CONCLUSIONS Choosing an appropriate sample size is crucial if a study is to inform clinical practice. The number of patients recruited into the trial needs to be sufficient to answer the objectives; however, the number should not be higher than necessary to avoid unnecessary burden on patients and wasting precious resources. The choice of the target difference is a key part of this process under the conventional approach to sample size calculations. This document provides advice and recommendations to improve practice and reporting regarding this aspect of trial design. Future work could extend the work to address other less common approaches to the sample size calculations, particularly in terms of appropriate reporting items. FUNDING Funded by the Medical Research Council (MRC) UK and the National Institute for Health Research as part of the MRC-National Institute for Health Research Methodology Research programme.
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Affiliation(s)
- Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Steven A Julious
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - William Sones
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lisa V Hampson
- Statistical Methodology and Consulting, Novartis Pharma AG, Basel, Switzerland
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephen J Walters
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Cf Wilson
- Cambridge Centre for Health Services Research, Cambridge Clinical Trials Unit University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Nigel Stallard
- Warwick Medical School, Statistics and Epidemiology, University of Warwick, Coventry, UK
| | - Joanne C Rothwell
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin Bland
- Department of Health Sciences, University of York, York, UK
| | - Louise Brown
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK
| | - David Armstrong
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Douglas Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Luke D Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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4
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Alma H, de Jong C, Jelusic D, Wittmann M, Schuler M, Kollen B, Sanderman R, Kocks J, Schultz K, van der Molen T. Baseline health status and setting impacted minimal clinically important differences in COPD: an exploratory study. J Clin Epidemiol 2019; 116:49-61. [PMID: 31362055 DOI: 10.1016/j.jclinepi.2019.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/09/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Minimal clinically important differences (MCIDs) are used as fixed numbers in the interpretation of clinical trials. Little is known about its dynamics. This study aims to explore the impact of baseline score, study setting, and patient characteristics on health status MCIDs in chronic obstructive pulmonary disease (COPD). STUDY DESIGN AND SETTING Baseline and follow-up data on the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and St. George's Respiratory Questionnaire (SGRQ) were retrospectively analyzed from pulmonary rehabilitation (PR) and routine clinical practice (RCP). Anchor- and distribution-based MCID estimates were calculated and tested between settings, gender, age, Global initiative for Obstructive Lung Disease (GOLD) classification, comorbidities, and baseline health status. RESULTS In total, 658 patients were included with 2,299 change score measurements. MCID estimates for improvement and deterioration ranged for all subgroups 0.50-6.30 (CAT), 0.10-0.84 (CCQ), and 0.33-12.86 (SGRQ). Larger MCID estimates for improvement and smaller ones for deterioration were noted in patients with worse baseline health status, females, elderly, GOLD I/II patients, and patients with less comorbidities. Estimates from PR were larger. CONCLUSION Baseline health status and setting affected MCID estimates of COPD health status questionnaires. Patterns were observed for gender, age, spirometry classification, and comorbidity levels. These outcomes would advocate the need for tailored MCIDs.
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Affiliation(s)
- Harma Alma
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Corina de Jong
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Danijel Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Schuler
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Boudewijn Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Janwillem Kocks
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Konrad Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Thys van der Molen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Jakobsen JC, Ovesen C, Winkel P, Hilden J, Gluud C, Wetterslev J. Power estimations for non-primary outcomes in randomised clinical trials. BMJ Open 2019; 9:e027092. [PMID: 31175197 PMCID: PMC6588976 DOI: 10.1136/bmjopen-2018-027092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE AND METHODS It is rare that trialists report power estimations of non-primary outcomes. In the present article, we will describe how to define a valid hierarchy of outcomes in a randomised clinical trial, to limit problems with Type I and Type II errors, using considerations on the clinical relevance of the outcomes and power estimations. CONCLUSION Power estimations of non-primary outcomes may guide trialists in classifying non-primary outcomes as secondary or exploratory. The power estimations are simple and if they are used systematically, more appropriate outcome hierarchies can be defined, and trial results will become more interpretable.
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Affiliation(s)
- Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Christian Ovesen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen Hilden
- Department of Public Health Research, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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6
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Rothwell JC, Julious SA, Cooper CL. A study of target effect sizes in randomised controlled trials published in the Health Technology Assessment journal. Trials 2018; 19:544. [PMID: 30305146 PMCID: PMC6180439 DOI: 10.1186/s13063-018-2886-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When designing a randomised controlled trial (RCT), an important consideration is the sample size required. This is calculated from several components; one of which is the target difference. This study aims to review the currently reported methods of elicitation of the target difference as well as to quantify the target differences used in Health Technology Assessment (HTA)-funded trials. METHODS Trials were identified from the National Institute of Health Research Health Technology Assessment journal. A total of 177 RCTs published between 2006 and 2016 were assessed for eligibility. Eligibility was established by the design of the trial and the quality of data available. The trial designs were parallel-group, superiority RCTs with a continuous primary endpoint. Data were extracted and the standardised anticipated and observed effect size estimates were calculated. Exclusion criteria was based on trials not providing enough detail in the sample size calculation and results, and trials not being of parallel-group, superiority design. RESULTS A total of 107 RCTs were included in the study from 102 reports. The most commonly reported method for effect size derivation was a review of evidence and use of previous research (52.3%). This was common across all clinical areas. The median standardised target effect size was 0.30 (interquartile range: 0.20-0.38), with the median standardised observed effect size 0.11 (IQR 0.05-0.29). The maximum anticipated and observed effect sizes were 0.76 and 1.18, respectively. Only two trials had anticipated target values above 0.60. CONCLUSION The most commonly reported method of elicitation of the target effect size is previous published research. The average target effect size was 0.3. A clear distinction between the target difference and the minimum clinically important difference is recommended when designing a trial. Transparent explanation of target difference elicitation is advised, with multiple methods including a review of evidence and opinion-seeking advised as the more optimal methods for effect size quantification.
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Affiliation(s)
- Joanne C. Rothwell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- The Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Steven A. Julious
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L. Cooper
- Sheffield Clinical Trials Unit, University of Sheffield, Sheffield, UK
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Saito YA, Camilleri M. Editorial: patient assessment of constipation-symptoms (PAC-SYM) questionnaire has a minimal important difference. Aliment Pharmacol Ther 2018; 47:138-139. [PMID: 29226416 DOI: 10.1111/apt.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- Y A Saito
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - M Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Misono S, Yueh B, Stockness AN, House ME, Marmor S. Minimal Important Difference in Voice Handicap Index-10. JAMA Otolaryngol Head Neck Surg 2017; 143:1098-1103. [PMID: 28973078 DOI: 10.1001/jamaoto.2017.1621] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The minimal important difference (MID) on patient-reported outcome measures can indicate how much of a change on that scale is meaningful. Objective To use an anchor-based approach to estimate MID in the Voice Handicap Index-10 (VHI-10) total score. Design, Setting, and Participants In this cohort study, a volunteer sample of adult patients visiting the voice clinic at the University of Minnesota from April 7, 2013, through July 3, 2016, completed the VHI-10 (range, 0-40, with higher scores indicating greater voice-related handicap) at baseline and 2 weeks later in conjunction with a global rating of change. An anchor-based approach was used to identify an MID. The association between the global change score and change in VHI-10 score was analyzed using Pearson rank correlation. A distribution-based method was used to corroborate the findings. Main Outcome and Measures Global rating of change on the VHI-10. Results Of the 273 participants, 183 (67.0%) were women and 90 (33.0%) were men (mean [SD] age, 54.3 [15.6] years); 259 (94.9%) were white. Participants had a variety of voice disorders, most commonly muscle tension dysphonia, irritable larynx, benign vocal fold lesions, and motion abnormalities. Among patients reporting no change on the global change score, the mean (SD) change in VHI-10 score was 1 (5). Among those reporting a small change, the mean (SD) change in VHI-10 was also 1 (5). Among those reporting a moderate change in voice symptoms, the mean (SD) change in VHI-10 score was 6 (8). Among those with a large change, the mean (SD) change in VHI-10 score was 9 (13). The correlation between the global change score and the change in VHI-10 score was 0.32 (95% CI, 0.12-0.49). Distribution-based analyses identified effect sizes comparable to those of the anchor-based categories. Conclusions and Relevance These findings suggest that a difference of 6 on the VHI-10 may represent an MID. This difference was associated with a moderate change on the global rating scale, and the small-change and no-change categories were indistinguishable. Given the lack of differentiation between small and no change and the modest correlation between the global change score and change in the VHI-10 score, additional studies are needed.
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Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology, University of Minnesota, Minneapolis
| | - Bevan Yueh
- Department of Otolaryngology, University of Minnesota, Minneapolis
| | - Ali N Stockness
- Department of Otolaryngology, University of Minnesota, Minneapolis
| | - Meaghan E House
- Department of Otolaryngology, University of Minnesota, Minneapolis
| | - Schelomo Marmor
- Department of Otolaryngology, University of Minnesota, Minneapolis.,Department of Surgery, University of Minnesota, Minneapolis
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Abstract
Introduction A main goals of palliative care is to improve the health-related quality of life (QOL) of patients with advanced illnesses. The objective of this narrative review is to provide an updated synopsis on the use of QOL questionnaires in the palliative care setting. Areas covers Focusing on the palliative cares setting, we will define QOL, discuss how QOL instruments can be used clinically and in research, review approaches to validate these questionnaires, and how they can be used in utility analyses. Expert opinion/commentary Several QOL questionnaires, such as EORTC-QLQ-C30, McGill QOL questionnaire and EQ-5D have been validated in the palliative care setting. However, significant gaps impede their application, including lack of determination of their responsiveness to change and minimal clinically important differences, the need to conduct more psychometric validation on QOL questionnaires among patients at various stages of disease trajectory, and the paucity of studies examining utility and cost-effectiveness. Further research is needed to address these knowledge gaps so QOL questionnaires can be better used to inform clinical practice and research.
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Affiliation(s)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD D Anderson Cancer Center, Houston, TX, USA, 77030
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10
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Devji T, Guyatt GH, Lytvyn L, Brignardello-Petersen R, Foroutan F, Sadeghirad B, Buchbinder R, Poolman RW, Harris IA, Carrasco-Labra A, Siemieniuk RAC, Vandvik PO. Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations. BMJ Open 2017; 7:e015587. [PMID: 28495818 PMCID: PMC5777462 DOI: 10.1136/bmjopen-2016-015587] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify the most credible anchor-based minimal important differences (MIDs) for patient important outcomes in patients with degenerative knee disease, and to inform BMJ Rapid Recommendations for arthroscopic surgery versus conservative management DESIGN: Systematic review. OUTCOME MEASURES Estimates of anchor-based MIDs, and their credibility, for knee symptoms and health-related quality of life (HRQoL). DATA SOURCES MEDLINE, EMBASE and PsycINFO. ELIGIBILITY CRITERIA We included original studies documenting the development of anchor-based MIDs for patient-reported outcomes (PROs) reported in randomised controlled trials included in the linked systematic review and meta-analysis and judged by the parallel BMJ Rapid Recommendations panel as critically important for informing their recommendation: measures of pain, function and HRQoL. RESULTS 13 studies reported 95 empirically estimated anchor-based MIDs for 8 PRO instruments and/or their subdomains that measure knee pain, function or HRQoL. All studies used a transition rating (global rating of change) as the anchor to ascertain the MID. Among PROs with more than 1 estimated MID, we found wide variation in MID values. Many studies suffered from serious methodological limitations. We identified the following most credible MIDs: Western Ontario and McMaster University Osteoarthritis Index (WOMAC; pain: 12, function: 13), Knee injury and Osteoarthritis Outcome Score (KOOS; pain: 12, activities of daily living: 8) and EuroQol five dimensions Questionnaire (EQ-5D; 0.15). CONCLUSIONS We were able to distinguish between more and less credible MID estimates and provide best estimates for key instruments that informed evidence presentation in the associated systematic review and judgements made by the Rapid Recommendation panel. TRIAL REGISTRATION NUMBER CRD42016047912.
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Affiliation(s)
- Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Romina Brignardello-Petersen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence-Based Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Farid Foroutan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Behnam Sadeghirad
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute; Suite 41 Cabrini Medical Centre, Malvern, Victoria, Australia
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Ian A Harris
- South Western Sydney Clinical School, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Level 2, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence-Based Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Reed A C Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Per O Vandvik
- Department of Medicine, Innlandet Hospital Trust-Gjøvik, Gjøvik, Norway
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11
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Ebrahim S, Vercammen K, Sivanand A, Guyatt GH, Carrasco-Labra A, Fernandes RM, Crawford MW, Nesrallah G, Johnston BC. Minimally Important Differences in Patient or Proxy-Reported Outcome Studies Relevant to Children: A Systematic Review. Pediatrics 2017; 139:peds.2016-0833. [PMID: 28196931 DOI: 10.1542/peds.2016-0833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT No study has characterized and appraised all anchor-based minimally important differences (MIDs) associated with patient-reported outcome (PRO) instruments in pediatric studies. OBJECTIVE To complete a comprehensive systematic survey and appraisal of published anchor-based MIDs associated with PRO instruments used in children. DATA SOURCES Medline, Embase, and PsycINFO (1989 to February 11, 2015). STUDY SELECTION Studies reporting empirical ascertainment of anchor-based MIDs among PROs used in pediatric care. DATA EXTRACTION All pertinent data items related to the characteristics of PRO instruments, anchors, and MIDs. RESULTS Of 4179 unique citations, 30 studies (including 32 cohorts) proved eligible and reported on 28 unique PROs (8 generic, 13 disease-specific, 5 symptoms-specific, 2 function-specific), with 9 (32%) classified as patient-reported, 11 (39%) proxy-reported, and 8 (29%) both patient- and proxy-reported. Of the 30 studies, we rated 14 (44%) as providing highly credible estimates of the MID. Most cohorts (n = 20, 62%) recorded patients' direct response to the target PRO and the use of an independent standard of comparison (n = 25, 78%). Most, however, failed to effectively report measurement properties of the anchor (n = 24, 75%). LIMITATIONS We have not yet addressed the measurement properties of instrument to measure credibility; our search was restricted to 3 electronic sources, and we used a single data abstractor. CONCLUSIONS Our study found 28 PROs that have been developed for children, with fewer than half providing credible estimates. Clinicians, clinical trialists, systematic reviewers, and guideline developers seeking to effectively summarize and interpret results of studies addressing PROs in child health are likely to find our comprehensive compendium of MIDs of use, both in providing best estimates of MIDs and identifying credible estimates.
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Affiliation(s)
- Shanil Ebrahim
- Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Research Institute, and.,Departments of Clinical Epidemiology and Biostatistics and.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
| | - Kelsey Vercammen
- Department of Epidemiology, Harvard University, Cambridge, Massachusetts
| | - Arunima Sivanand
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gordon H Guyatt
- Departments of Clinical Epidemiology and Biostatistics and.,Medicine, and Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alonso Carrasco-Labra
- Departments of Clinical Epidemiology and Biostatistics and.,Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Independencia, Santiago, Chile
| | | | - Mark W Crawford
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gihad Nesrallah
- Nephrology Program, Humber River Regional Hospital, Toronto, Ontario, Canada.,Division of Nephrology, University of Western Ontario, London, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; and
| | - Bradley C Johnston
- Systematic Overviews through advancing Research Technology (SORT), Child Health Evaluative Sciences, The Research Institute, and .,Departments of Clinical Epidemiology and Biostatistics and.,Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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12
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Shrier I, Christensen R, Juhl C, Beyene J. Meta-analysis on continuous outcomes in minimal important difference units: an application with appropriate variance calculations. J Clin Epidemiol 2016; 80:57-67. [PMID: 27480962 DOI: 10.1016/j.jclinepi.2016.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. STUDY DESIGN AND SETTING Meta-analyses of published data. We calculated the variance of MDMID as a random variable using the delta method and as a constant. We assessed performance under different assumptions. We compare meta-analysis results from data originally used to present the MDMID and data from osteoarthritis studies using different domain instruments. RESULTS Depending on the data set and depending on the values of rho and coefficient of variation of the MID (CoVMID), estimates of treatment effect and P-values between an approach considering the MID as a constant vs. as a random variable may differ appreciably. Using our data sets, we provide examples of the potential magnitude. When rho = 0.5 and CoVMID = 0.8, considering MID as a constant overestimated the treatment effect by 33-110% and decreased the P-value for heterogeneity from above 0.95 to below 0.08. When rho = 0.8 and CoVMID = 0.5, the magnitude of the effects was similar. CONCLUSIONS Considering MID as a random variable avoids unrealistic assumptions and provides more appropriate treatment effect estimates.
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Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Cote Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada.
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Copenhagen F, Denmark
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Joseph Beyene
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, MDCL 3211, Hamilton, ON L8S 4K1, Canada; Department of Mathematics & Statistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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13
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Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma 2015; 33:468-81. [PMID: 26529320 PMCID: PMC4779323 DOI: 10.1089/neu.2015.4192] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. We included four RCTs and 17 observational studies. MPS was not associated with an increase in long-term motor score recovery (two RCTs: 335 participants; mean difference [MD], −1.11; 95% confidence interval [CI], −4.75 to 2.53; p = 0.55, low confidence; two observational studies: 528 participants; MD, 1.37; 95% CI, −3.08 to 5.83; p = 0.55, very low confidence) or improvement by at least one motor grade (three observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI, 0.53–1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated superior short-term motor score improvement if MPS was administered within 8 h of injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97–7.94; p = 0.01, low confidence), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI, 1.13–4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited.
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Affiliation(s)
- Nathan Evaniew
- 1 Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Emilie P Belley-Côté
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Nader Fallah
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopedics, Blusson Spinal Cord Center, University of British Columbia , Vancouver, British Columbia, Canada
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