PMID- 23176164
OWN - NLM
STAT- MEDLINE
DCOM- 20130516
LR  - 20220409
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 18
IP  - 2
DP  - 2013 Feb
TI  - Assessment of the minimum clinically important difference in pain, disability, 
      and quality of life after anterior cervical discectomy and fusion: clinical 
      article.
PG  - 154-60
LID - 10.3171/2012.10.SPINE12312 [doi]
AB  - OBJECT: Treatment effectiveness following spine surgery is usually gauged with 
      the help of patient-reported outcome (PRO) questionnaires. Although these 
      questionnaires assess pain, disability, and general health state, their numerical 
      scores lack direct, clinically significant meaning. Thus, the concept of minimum 
      clinically important difference (MCID) has been introduced, which indicates the 
      smallest change in an outcome measure that reflects clinically meaningful 
      improvement to patients. The authors set out to determine anterior cervical 
      discectomy and fusion (ACDF)-specific MCID values for the visual analog scale 
      (VAS), Neck Disability Index (NDI), 12-Item Short-Form Health Survey (SF-12), and 
      EQ-5D (the EuroQol health survey) in patients undergoing ACDF for cervical 
      radiculopathy. METHODS: Data on 69 patients who underwent ACDF for cervical 
      radiculopathy were collected in the authors' web-based, prospective registry 
      during the study enrollment period. Patient-reported outcome questionnaires 
      (VAS-neck pain [NP]), VAS-arm pain [AP], NDI, SF-12, and EQ-5D) were administered 
      preoperatively and 3 months postoperatively, allowing 3-month change scores to be 
      calculated. Four established calculation methods were used to calculate 
      anchor-based MCID values using the North American Spine Society (NASS) patient 
      satisfaction scale as the anchor: 1) average change, 2) minimum detectable change 
      (MDC), 3) change difference, and 4) receiver operating characteristic (ROC) curve 
      analysis. RESULTS: Sixty-one patients (88%) were available at follow-up. At 3 
      months postoperatively, statistically significant improvement (p < 0.001) was 
      observed for the following PROs assessed: VAS-NP (2.7 +/- 3.3), VAS-AP (3.7 +/- 3.6), 
      NDI (23.2% +/- 19.7%), SF-12 physical component score (PCS; 10.7 +/- 9.7), and EQ-5D 
      (0.20 +/- 0.23 QALY). Improvement on the SF-12 mental component score (MCS) trended 
      toward significance (3.4 +/- 11.4, p = 0.07). The 4 MCID calculation methods 
      generated a range of MCID values for each of the PROs: VAS-NP 2.6-4.0, VAS-AP 
      2.4-4.2, NDI 16.0%-27.6%, SF-12 PCS 7.0-12.2, SF-12 MCS 0.0-7.2, and EQ-5D 
      0.05-0.24 QALY. The maximum area under the curve (AUC) was observed for NDI 
      (0.80), and the minimum AUC was observed for SF-12 MCS (0.66) and EQ-5D (0.67). 
      Based on the MDC approach, the MCID threshold was 2.6 points for VAS-NP, 4.1 
      points for VAS-AP, 17.3% for NDI, 8.1 points for SF-12 PCS, 4.7 points for SF-12 
      MCS, and 0.24 QALY for EQ-5D. The mean improvement in patient scores at 3 months 
      surpassed the MCID threshold for VAS-NP, NDI, and SF-12 PCS but not for VAS-AP, 
      SF-12 MCS, and EQ-5D. CONCLUSIONS: The ACDF-specific MCID is highly variable 
      depending on the calculation technique used. The MDC approach seems to be most 
      appropriate for MCID calculations in the ACDF population, as it provided a 
      threshold value above the 95% confidence interval of nonresponders (greater than 
      the measurement error) and was closest to the average change of most PROs 
      reported by responders. When the MDC method was applied with the NASS patient 
      satisfaction scale as the anchor, the MCID thresholds were 2.6 points for VAS-NP, 
      4.1 points for VAS-AP, 17.3% for NDI, 8.1 points for SF-12 PCS, 4.7 points for 
      SF-12 MCS, and 0.24 QALY for EQ-5D.
FAU - Parker, Scott L
AU  - Parker SL
AD  - Department of Neurological Surgery and Vanderbilt Spinal Column Surgical Quality 
      and Outcomes Research Laboratory, Vanderbilt University Medical Center, 
      Nashville, Tennessee, USA. scott.parker@vanderbilt.edu
FAU - Godil, Saniya S
AU  - Godil SS
FAU - Shau, David N
AU  - Shau DN
FAU - Mendenhall, Stephen K
AU  - Mendenhall SK
FAU - McGirt, Matthew J
AU  - McGirt MJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121123
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cervical Vertebrae/*surgery
MH  - *Disability Evaluation
MH  - *Diskectomy
MH  - Female
MH  - Health Surveys
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement/*methods
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - *Quality of Life
MH  - Radiculopathy/surgery
MH  - *Spinal Fusion
MH  - Treatment Outcome
EDAT- 2012/11/28 06:00
MHDA- 2013/05/17 06:00
CRDT- 2012/11/27 06:00
PHST- 2012/11/27 06:00 [entrez]
PHST- 2012/11/28 06:00 [pubmed]
PHST- 2013/05/17 06:00 [medline]
AID - 10.3171/2012.10.SPINE12312 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2013 Feb;18(2):154-60. doi: 10.3171/2012.10.SPINE12312. Epub 
      2012 Nov 23.