PMID- 24136679
OWN - NLM
STAT- MEDLINE
DCOM- 20140818
LR  - 20131118
IS  - 0942-0940 (Electronic)
IS  - 0001-6268 (Linking)
VI  - 155
IP  - 12
DP  - 2013 Dec
TI  - Usefulness of minimum clinically important difference for assessing patients with 
      subaxial degenerative cervical spine disease: statistical versus substantial 
      clinical benefit.
PG  - 2345-54; discussion 2355
LID - 10.1007/s00701-013-1909-4 [doi]
AB  - BACKGROUND: The measurement of the therapeutic outcome of cervical spine 
      surgeries commonly relies on four main patient reported outcomes (PROs): Neck 
      Disability Index (NDI), Visual Analog Scale (VAS) for pain, and Short Form-36 
      (SF-36) Physical (PCS) and Mental (MCS) Component Summary. However, the clinical 
      impact of such scores and how they could effectively measure therapeutic efficacy 
      remains unclear. In this context, the concept of minimum clinically important 
      difference (MCID) is developing into the standard by which to evaluate 
      treatments, patient satisfaction and cost-effectiveness. METHODS: Eighty-eight 
      consecutive patients undergoing surgery for subaxial degenerative cervical spine 
      disease were selected from a prospective blinded database. PROs (NDI, PCS, MCS 
      and VAS) were collected preoperatively, and together with blinded Surgeon Ratings 
      (SR) at 3 months and 6 months post-surgery. Four anchor-based approaches were 
      used to calculate different MCIDs. Three anchors (VAS, HTI (Health Transition 
      Item of the SF-36) and SR) were used to evaluate surgery outcome. The best 
      clinically and statistically relevant MCID was chosen. RESULTS: On average, all 
      patients presented with a statistically significant improvement (p < 0.001) 
      postoperatively for NDI (27.42 to 19.42), PCS (33.02 to 42.03), MCS (44 to 50.74) 
      and VAS (2.85 to 1.93). The four MCID anchor-based approaches yielded a range of 
      values for each PRO: 2.23-16.59 for PCS, 0.11-16.27 for MCS and 2.72-12.08 for 
      NDI. When compared to the VAS and HTI anchors, the area under the ROC curve was 
      greater for SR. This finding suggests that SR may be a more reliable anchor for 
      MCID calculation. CONCLUSION: The MDC (minimum detectable change) approach 
      together with the SR anchor appears to be the most appropriate MCID method. It 
      offers the greatest area under the ROC curve (threshold above the 95 % CI), and 
      the choice of the anchor did not significantly affect this result. MCID values 
      for this dataset were 5.6 for PCS, 5.12 for MCS and 2.41 for NDI.
FAU - Auffinger, Brenda
AU  - Auffinger B
AD  - Section of Neurosurgery, The University of Chicago, 5841 South Maryland Ave, 
      MC3026, J341, Chicago, IL, 60637, USA, bauffinger@surgery.bsd.uchicago.edu.
FAU - Lam, Sandi
AU  - Lam S
FAU - Shen, Jingjing
AU  - Shen J
FAU - Thaci, Bart
AU  - Thaci B
FAU - Roitberg, Ben Z
AU  - Roitberg BZ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131018
PL  - Austria
TA  - Acta Neurochir (Wien)
JT  - Acta neurochirurgica
JID - 0151000
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Disability Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pain/*diagnosis/etiology
MH  - *Pain Measurement/methods
MH  - Prospective Studies
MH  - ROC Curve
MH  - Spinal Diseases/*complications/diagnosis/therapy
MH  - Treatment Outcome
EDAT- 2013/10/19 06:00
MHDA- 2014/08/19 06:00
CRDT- 2013/10/19 06:00
PHST- 2013/07/31 00:00 [received]
PHST- 2013/10/02 00:00 [accepted]
PHST- 2013/10/19 06:00 [entrez]
PHST- 2013/10/19 06:00 [pubmed]
PHST- 2014/08/19 06:00 [medline]
AID - 10.1007/s00701-013-1909-4 [doi]
PST - ppublish
SO  - Acta Neurochir (Wien). 2013 Dec;155(12):2345-54; discussion 2355. doi: 
      10.1007/s00701-013-1909-4. Epub 2013 Oct 18.