PMID- 15801011
OWN - NLM
STAT- MEDLINE
DCOM- 20050711
LR  - 20071115
IS  - 0315-162X (Print)
IS  - 0315-162X (Linking)
VI  - 32
IP  - 4
DP  - 2005 Apr
TI  - Expanding the definition of clinical differences: from minimally clinically 
      important differences to really important differences. Analyses in 8931 patients 
      with rheumatoid arthritis.
PG  - 583-9
AB  - OBJECTIVE: Minimally clinically important differences (MCID) have become an 
      important way to interpret data of randomized clinical trials (RCT), but do not 
      reflect the degree of improvement consistent with a "really important difference" 
      (RID). To define RID, we compared mean and/or least desirable clinical states 
      with best and/or most desirable states. METHODS: In total, 8931 patients with 
      rheumatoid arthritis (RA) < 65 years of age completed the Health Assessment 
      Questionnaire (HAQ) and Medical Outcomes Survey Short Form 36 Physical Component 
      Score (PCS). Definitions of RID were based on values for HAQ and PCS 
      corresponding with the best and worst category of the following conditions: 
      disabled vs not disabled: joint replacement vs no joint replacement; < poverty 
      level vs > poverty level; very satisfied with health vs not; and independent in 
      participation activities vs not. RESULTS: In contrast to published MCID values 
      for the HAQ of approximately 0.22, RID was as high as 0.76 using objective 
      reference conditions and 0.87 using the subjective measure of dependence vs 
      independence. The HAQ score of independent RA patients was 0.38 (SD 0.45), and 
      was 0.42 (SD 0.53) for those very satisfied with their health. The difference in 
      HAQ scores between disabled and working patients was approximately 0.75. PCS 
      differences were similarly increased. CONCLUSION: RID values are 3 to 4 times 
      greater than MCID values. Although MCID are meaningful statistics for RCT, the 
      RID percentage achieved [(actual improvement/RID) 100%] is a simple way to put 
      the results of RCT in a broader perspective that gives an idea of how much 
      additional treatment effect is needed.
FAU - Wolfe, Frederick
AU  - Wolfe F
AD  - Arthritis Research Center Foundation and the University of Kansas School of 
      Medicine, Wichita, Kansas 67214, USA. fwolfe@arthritis-research.org
FAU - Michaud, Kaleb
AU  - Michaud K
FAU - Strand, Vibeke
AU  - Strand V
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - J Rheumatol
JT  - The Journal of rheumatology
JID - 7501984
SB  - IM
CIN - J Rheumatol. 2006 Feb;33(2):434; author reply 435. PMID: 16465677
MH  - *Arthritis, Rheumatoid/pathology/physiopathology/therapy
MH  - *Disability Evaluation
MH  - Disease Progression
MH  - Female
MH  - *Health Status
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Rheumatology/*methods
MH  - *Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2005/04/01 09:00
MHDA- 2005/07/12 09:00
CRDT- 2005/04/01 09:00
PHST- 2005/04/01 09:00 [pubmed]
PHST- 2005/07/12 09:00 [medline]
PHST- 2005/04/01 09:00 [entrez]
AID - 0315162X-32-583 [pii]
PST - ppublish
SO  - J Rheumatol. 2005 Apr;32(4):583-9.