PMID- 24220005
OWN - NLM
STAT- MEDLINE
DCOM- 20140925
LR  - 20220408
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 74
IP  - 2
DP  - 2014 Feb
TI  - Measuring surgical outcomes in subaxial degenerative cervical spine disease 
      patients: minimum clinically important difference as a tool for determining 
      meaningful clinical improvement.
PG  - 206-13; discussion 213-4
LID - 10.1227/NEU.0000000000000247 [doi]
AB  - BACKGROUND: Although the concept of minimum clinically important difference 
      (MCID) as a measurement of surgical outcome has been extensively studied, there 
      is lack of consensus on the most valid or clinically relevant MCID calculation 
      approach. OBJECTIVE: To compare the range of MCID threshold values obtained by 
      different anchor-based and distribution-based approaches to determine the best 
      clinically meaningful and statistically significant MCID for our studied group. 
      METHODS: Eighty-eight consecutive patients undergoing surgery for subaxial 
      degenerative cervical spine disease were analyzed from a prospective blinded 
      database. Preoperative, 3-, and 6-month postoperative patient reported outcome 
      (PRO) scores and blinded surgeon ratings were collected. Four calculation methods 
      were used to calculate MCID threshold values: average change, change difference, 
      minimum detectable change, and receiver operating characteristic (ROC) curve. 
      Three anchors were used to evaluate meaningful improvement postsurgery: health 
      transition item, patient overall status, and surgeon ratings. RESULTS: On 
      average, all patients had a statistically significant improvement (P < .001) 
      postoperatively for neck disability index (score 27.42 preoperatively to 19.42 
      postoperatively), physical component of the Short Form of the Medical Outcomes 
      Study (SF-36) (33.02-42.23), mental component of the SF-36 (44-50.74), and visual 
      analog scale (2.85-1.93). The 4 MCID approaches yielded a range of values for 
      each PRO: 2.23 to 16.59 for physical component of the SF-36, 0.11 to 16.27 for 
      mental component of the SF-36, and 2.72 to 12.08 for neck disability index. In 
      comparison with health transition item and patient overall status anchors, the 
      area under the ROC curve was consistently greater for surgeon ratings for all 4 
      PROs. CONCLUSION: Minimum detectable change together with surgeon ratings anchor 
      appears to be the most appropriate MCID method. Based on our findings, this 
      combination offers the greatest area under the ROC curve (threshold above the 95% 
      confidence interval). The choice of the anchor did not significantly affect this 
      result.
FAU - Auffinger, Brenda
AU  - Auffinger B
AD  - *The University of Chicago, Section of Neurosurgery, Chicago, Illinois; double daggerBaylor 
      College of Medicine, Texas Children's Hospital, Houston, Texas.
FAU - Lam, Sandi
AU  - Lam S
FAU - Shen, Jingjing
AU  - Shen J
FAU - Roitberg, Ben Z
AU  - Roitberg BZ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Cervical Vertebrae/surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neurosurgical Procedures/adverse effects/methods
MH  - Patient Acuity
MH  - Prospective Studies
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Self Report
MH  - Spinal Diseases/diagnosis/*surgery
MH  - Surveys and Questionnaires
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2013/11/14 06:00
MHDA- 2014/09/26 06:00
CRDT- 2013/11/14 06:00
PHST- 2013/11/14 06:00 [entrez]
PHST- 2013/11/14 06:00 [pubmed]
PHST- 2014/09/26 06:00 [medline]
AID - 10.1227/NEU.0000000000000247 [doi]
PST - ppublish
SO  - Neurosurgery. 2014 Feb;74(2):206-13; discussion 213-4. doi: 
      10.1227/NEU.0000000000000247.