Minimal clinically important difference: The basics

This article is part of a collaborative methodological series of narrative reviews on biostatistics and clinical epidemiology. This review aims to present basic concepts about the minimal clinically important difference and its use in the field of clinical research and evidence synthesis. The minimal clinically important difference is defined as the smallest difference in score in any domain or outcome of interest that patients can perceive as beneficial. It is a useful concept in several aspects since it links the magnitude of change with treatment decisions in clinical practice and emphasizes the primacy of the patients perception, affected by endless variables such as time, place, and current state of health, all of which can cause significant variability in results.

Addition of aerobic exercise to antidepressant drug monotherapy for major depressive disorder in adults

INTRODUCTION

Major depressive disorder is frequent and implies a high morbimortality. The addition of exercise has been proposed to improve the response rate to pharmacological monotherapy. However, this intervention is still controversial.

METHODS

We searched Epistemonikos, the largest database of systematic reviews in health, maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane. We extracted data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis, and prepared a summary table of the results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method.

RESULTS AND CONCLUSIONS

We identified 20 systematic reviews that together included 15 primary studies. Of these, eight were randomized trials. We con-clude that the addition of aerobic exercise to pharmacological monotherapy for patients with major depression could slightly decrease the severity of depressive symptoms with low certainty of evidence.