PMID- 25265276
OWN - NLM
STAT- MEDLINE
DCOM- 20141203
LR  - 20221207
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 124
IP  - 10
DP  - 2014 Oct
TI  - Physiology-based minimum clinically important difference thresholds in adult 
      laryngotracheal stenosis.
PG  - 2313-20
LID - 10.1002/lary.24641 [doi]
AB  - OBJECTIVES/HYPOTHESIS: Delivering evidence-based patient care is predicated on 
      the availability of objective and validated outcome measures. We aimed to 
      calculate physiology-based minimum clinically important difference (MCID) values 
      for adult laryngotracheal stenosis (LTS). STUDY DESIGN: Prospective observational 
      study. METHODS: Patient demographics, morbidities, and stenosis severity were 
      assessed preoperatively. Flow-volume loops and Medical Research Council (MRC) 
      dyspnea grades were measured in 21 males and 44 females before and 6 to 8 weeks 
      after airway surgery, and before treating recurrent disease in 10 patients. 
      Anchor and distribution-based methodologies were used to calculate MCIDs for 
      treatment efficacy and disease recurrence respectively. RESULTS: The mean age at 
      treatment was 46 +/- 16 years. The most common etiology was idiopathic subglottic 
      stenosis (38%). Most lesions (66%) obstructed >70% of the lumen. There were 
      strong correlations between treatment-related changes in total peak flow (TPF) 
      (DeltaTPF) (peak expiratory flow + |peak inspiratory flow|) and the ratio of area 
      under the flow-volume loop (AUC) to forced vital capacity (FVC) (DeltaAUCTotal /FVC), 
      and treatment-related changes in the MRC grade (DeltaMRC) (r = -0.76 and r = -0.82, 
      respectively). Both TPF and AUCTotal /FVC discriminated between effective (DeltaMRC 
      <0) and ineffective (DeltaMRC >/=0) interventions, yielding MCID values of 4.2 L/s for 
      TPF and 2.1 L(2) /s for AUCTotal /FVC, respectively. Ten patients required airway 
      treatment for recurrent disease, and TPF and AUCTotal /FVC levels had 
      distribution-based MCID values of 0.9 and 0.6, respectively. CONCLUSIONS: 
      Flow-volume loops provide a quantitative method of objectively assessing outcomes 
      in LTS. TPF is the most convenient index for this purpose, but AUCTotal /FVC 
      provides marginally greater sensitivity and specificity.
CI  - (c) 2014 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Nouraei, S Mahmoud
AU  - Nouraei SM
AD  - Department of Cardiothoracic Surgery, University of Mazandaran School of Medical 
      Sciencs, Sari, Iran.
FAU - Franco, Ramon A
AU  - Franco RA
FAU - Dowdall, Jayme R
AU  - Dowdall JR
FAU - Nouraei, S A Reza
AU  - Nouraei SA
FAU - Mills, Heide
AU  - Mills H
FAU - Virk, Jag S
AU  - Virk JS
FAU - Sandhu, Guri S
AU  - Sandhu GS
FAU - Polkey, Mike
AU  - Polkey M
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20140404
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Airway Resistance/*physiology
MH  - Endoscopy/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Laryngostenosis/diagnosis/*physiopathology/therapy
MH  - Male
MH  - Middle Aged
MH  - Peak Expiratory Flow Rate/*physiology
MH  - Preoperative Period
MH  - Prospective Studies
MH  - Plastic Surgery Procedures/*methods
MH  - Reproducibility of Results
MH  - Severity of Illness Index
MH  - Tracheal Stenosis/diagnosis/*physiopathology
MH  - Treatment Outcome
MH  - Vital Capacity/*physiology
MH  - Young Adult
OTO - NOTNLM
OT  - Laryngotracheal stenosis
OT  - evidence-based medicine
OT  - flow-volume loops
OT  - minimum clinically important difference
OT  - outcome measures
OT  - pulmonary function test
EDAT- 2014/09/30 06:00
MHDA- 2014/12/15 06:00
CRDT- 2014/09/30 06:00
PHST- 2013/10/22 00:00 [received]
PHST- 2014/01/20 00:00 [revised]
PHST- 2014/02/03 00:00 [accepted]
PHST- 2014/09/30 06:00 [entrez]
PHST- 2014/09/30 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - 10.1002/lary.24641 [doi]
PST - ppublish
SO  - Laryngoscope. 2014 Oct;124(10):2313-20. doi: 10.1002/lary.24641. Epub 2014 Apr 4.