PMID- 15207508
OWN - NLM
STAT- MEDLINE
DCOM- 20041004
LR  - 20220410
IS  - 1090-3801 (Print)
IS  - 1090-3801 (Linking)
VI  - 8
IP  - 4
DP  - 2004 Aug
TI  - Minimal clinically important changes in chronic musculoskeletal pain intensity 
      measured on a numerical rating scale.
PG  - 283-91
AB  - OBJECTIVES: To determine the minimal clinically important difference (MCID) of 
      changes in chronic musculoskeletal pain intensity that is most closely associated 
      with improvement on the commonly used and validated measure of the patient's 
      global impression of change (PGIC), and to estimate the dependency of the MCID on 
      the baseline pain scores. METHODS: This was a prospective cohort study assessing 
      patient's pain intensity by the numerical rating scale (NRS) at baseline and at 
      the 3 month follow-up, and by a PGIC questionnaire. A one unit difference at the 
      lowest end of the PGIC ("slightly better") was used to define MCID as it reflects 
      the minimum and lowest degree of improvement that could be detected. In addition 
      we also calculated the NRS changes best associated with "much better" (two 
      units). In order to characterize the association between specific NRS change 
      scores (raw or percent) and clinically important improvement, the sensitivity and 
      specificity were calculated by the receiver operating characteristic (ROC) 
      method. PGIC was used as an external criterion to distinguish between improved or 
      non-improved patients. RESULTS: 825 patients with chronic musculoskeletal pain 
      (233 with osteoarthritis of the knee, 86 with osteoarthritis of the hip, 133 with 
      osteoarthritis of the hand, 290 with rheumatoid arthritis and 83 with ankylosing 
      spondylitis) were followed up. A consistent relationship between the change in 
      NRS and the PGIC was observed. On average, a reduction of one point or a 
      reduction of 15.0% in the NRS represented a MCID for the patient. A NRS change 
      score of -2.0 and a percent change score of -33.0% were best associated with the 
      concept of "much better" improvement. For this reason these values can be 
      considered as appropriate cut-off points for this measure. The clinically 
      significant changes in pain are non-uniform along the entire NRS. Patients with a 
      high baseline level of pain on the NRS (score of >7 cm), who experienced either a 
      slight improvement or a higher level of response, had absolute raw and percent 
      changes greater that did patients in the lower cohort (score of less than 4 cm). 
      CONCLUSIONS: These results are consistent with the recently published findings 
      generated by different methods and support the use of a "much better" improvement 
      on the pain relief as a clinically important outcome. A further confirmation in 
      other patient populations and different chronic pain syndromes will be needed.
FAU - Salaffi, Fausto
AU  - Salaffi F
AD  - Department of Rheumatology, University of Ancona, Ospedale A. Murri, ASL5, Via 
      dei Colli 52, 60035 Jesi (Ancona), Italy. fsalaff@tin.it
FAU - Stancati, Andrea
AU  - Stancati A
FAU - Silvestri, Carlo Alberto
AU  - Silvestri CA
FAU - Ciapetti, Alessandro
AU  - Ciapetti A
FAU - Grassi, Walter
AU  - Grassi W
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur J Pain
JT  - European journal of pain (London, England)
JID - 9801774
SB  - IM
MH  - Adult
MH  - Aged
MH  - Arthralgia/etiology/*psychology/therapy
MH  - Arthritis, Rheumatoid/psychology/therapy
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Educational Status
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Musculoskeletal Diseases/*psychology/therapy
MH  - Osteoarthritis/psychology/therapy
MH  - Osteoarthritis, Hip/psychology/therapy
MH  - Pain Measurement/*methods/standards/statistics & numerical data
MH  - Prospective Studies
MH  - ROC Curve
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Spondylitis, Ankylosing/psychology/therapy
MH  - *Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2004/06/23 05:00
MHDA- 2004/10/05 09:00
CRDT- 2004/06/23 05:00
PHST- 2003/05/27 00:00 [received]
PHST- 2003/09/23 00:00 [accepted]
PHST- 2004/06/23 05:00 [pubmed]
PHST- 2004/10/05 09:00 [medline]
PHST- 2004/06/23 05:00 [entrez]
AID - S1090380103001289 [pii]
AID - 10.1016/j.ejpain.2003.09.004 [doi]
PST - ppublish
SO  - Eur J Pain. 2004 Aug;8(4):283-91. doi: 10.1016/j.ejpain.2003.09.004.