PMID- 27597571
OWN - NLM
STAT- MEDLINE
DCOM- 20180109
LR  - 20240222
IS  - 2055-1010 (Electronic)
IS  - 2055-1010 (Linking)
VI  - 26
DP  - 2016 Sep 1
TI  - Health status instruments for patients with COPD in pulmonary rehabilitation: 
      defining a minimal clinically important difference.
PG  - 16041
LID - 10.1038/npjpcrm.2016.41 [doi]
AB  - The minimal clinically important difference (MCID) defines to what extent change 
      on a health status instrument is clinically relevant, which aids scientists and 
      physicians in measuring therapy effects. This is the first study that aimed to 
      establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) 
      Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George's 
      Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population 
      using multiple approaches. In total, 451 COPD patients participated in a 3-week 
      Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD 
      stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based 
      approaches, including patient-referencing, criterion-referencing and 
      questionnaire-referencing, and the distribution-based methods standard error of 
      measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and 
      criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 
      (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges 
      of 0.28-0.61 (CCQ), 1.46-3.08 (CAT) and 6.86-9.47 (SGRQ). The SEM, 1.96SEM and 
      0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 
      and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for 
      improvement. MCID estimates differed depending on the method used. Pooled 
      estimates suggest clinically relevant improvements needing to exceed 0.40 on the 
      CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD 
      patients. The MCIDs of the CAT and SGRQ in the literature might be too low, 
      leading to overestimation of treatment effects for patients with COPD.
FAU - Alma, Harma
AU  - Alma H
AD  - Department of General Practice, GRIAC Research Institute, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - de Jong, Corina
AU  - de Jong C
AD  - Department of General Practice, GRIAC Research Institute, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Jelusic, Danijel
AU  - Jelusic D
AD  - Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, 
      Bad Reichenhall, Germany.
FAU - Wittmann, Michael
AU  - Wittmann M
AD  - Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, 
      Bad Reichenhall, Germany.
FAU - Schuler, Michael
AU  - Schuler M
AD  - Department of Psychotherapy and Medical Psychology, Rehabilitation Sciences 
      Section, University of Wuerzburg, Wuerzburg, Germany.
FAU - Flokstra-de Blok, Bertine
AU  - Flokstra-de Blok B
AD  - Department of General Practice, GRIAC Research Institute, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Kocks, Janwillem
AU  - Kocks J
AD  - Department of General Practice, GRIAC Research Institute, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
FAU - Schultz, Konrad
AU  - Schultz K
AD  - Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, 
      Bad Reichenhall, Germany.
FAU - van der Molen, Thys
AU  - van der Molen T
AD  - Department of General Practice, GRIAC Research Institute, University of 
      Groningen, University Medical Center Groningen, Groningen, The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160901
PL  - England
TA  - NPJ Prim Care Respir Med
JT  - NPJ primary care respiratory medicine
JID - 101631999
SB  - IM
MH  - Female
MH  - Forced Expiratory Volume
MH  - *Health Status
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimal Clinically Important Difference
MH  - Patient Reported Outcome Measures
MH  - Pulmonary Disease, Chronic Obstructive/physiopathology/*rehabilitation
MH  - *Respiratory Therapy
MH  - Surveys and Questionnaires
PMC - PMC5011855
COIS- J.W.H.K. reports receiving personal fees from Novartis; personal fees from 
      Boehringer Ingelheim; grants and personal fees from GSK; grants from Stichting 
      Zorgdraad; personal fees from IPCRG; personal fees from Springer Media; and 
      travel arrangements from Chiesi BV, GlaxoSmithKline BV and IPCRG, all outside the 
      submitted work. K.S. received lecture fees from Boehringer, AstraZeneca, Berlin 
      Chemie, Novartis, Chiesi, Mundipharma, Takeda, GSK and MSD, all outside the 
      submitted work. T.v.d.M. developed the CCQ and holds the copyright. J.W.H.K. is 
      an Associate Editor of npj Primary Care Respiratory Medicine, but was not 
      involved in the editorial review of, nor the decision to publish, this article. 
      The remaining authors declare no conflict of interest.
EDAT- 2016/09/07 06:00
MHDA- 2018/01/10 06:00
PMCR- 2016/09/01
CRDT- 2016/09/07 06:00
PHST- 2016/02/08 00:00 [received]
PHST- 2016/05/03 00:00 [revised]
PHST- 2016/05/24 00:00 [accepted]
PHST- 2016/09/07 06:00 [entrez]
PHST- 2016/09/07 06:00 [pubmed]
PHST- 2018/01/10 06:00 [medline]
PHST- 2016/09/01 00:00 [pmc-release]
AID - npjpcrm201641 [pii]
AID - 10.1038/npjpcrm.2016.41 [doi]
PST - epublish
SO  - NPJ Prim Care Respir Med. 2016 Sep 1;26:16041. doi: 10.1038/npjpcrm.2016.41.