PMID- 28215182
OWN - NLM
STAT- MEDLINE
DCOM- 20170524
LR  - 20181202
IS  - 1741-7015 (Electronic)
IS  - 1741-7015 (Linking)
VI  - 15
IP  - 1
DP  - 2017 Feb 20
TI  - Pain relief that matters to patients: systematic review of empirical studies 
      assessing the minimum clinically important difference in acute pain.
PG  - 35
LID - 10.1186/s12916-016-0775-3 [doi]
LID - 35
AB  - BACKGROUND: The minimum clinically important difference (MCID) is used to 
      interpret the clinical relevance of results reported by trials and meta-analyses 
      as well as to plan sample sizes in new studies. However, there is a lack of 
      consensus about the size of MCID in acute pain, which is a core symptom affecting 
      patients across many clinical conditions. METHODS: We identified and 
      systematically reviewed empirical studies of MCID in acute pain. We searched 
      PubMed, EMBASE and Cochrane Library, and included prospective studies determining 
      MCID using a patient-reported anchor and a one-dimensional pain scale (e.g. 
      100 mm visual analogue scale). We summarised results and explored reasons for 
      heterogeneity applying meta-regression, subgroup analyses and individual patient 
      data meta-analyses. RESULTS: We included 37 studies (8479 patients). Thirty-five 
      studies used a mean change approach, i.e. MCID was assessed as the mean 
      difference in pain score among patients who reported a minimum degree of 
      improvement, while seven studies used a threshold approach, i.e. MCID was 
      assessed as the threshold in pain reduction associated with the best accuracy 
      (sensitivity and specificity) for identifying improved patients. Meta-analyses 
      found considerable heterogeneity between studies (absolute MCID: I(2) = 93%, 
      relative MCID: I(2) = 75%) and results were therefore presented qualitatively, 
      while analyses focused on exploring reasons for heterogeneity. The reported 
      absolute MCID values ranged widely from 8 to 40 mm (standardised to a 100 mm 
      scale) and the relative MCID values from 13% to 85%. From analyses of individual 
      patient data (seven studies, 918 patients), we found baseline pain strongly 
      associated with absolute, but not relative, MCID as patients with higher baseline 
      pain needed larger pain reduction to perceive relief. Subgroup analyses showed 
      that the definition of improved patients (one or several categories improvement 
      or meaningful change) and the design of studies (single or multiple measurements) 
      also influenced MCID values. CONCLUSIONS: The MCID in acute pain varied greatly 
      between studies and was influenced by baseline pain, definitions of improved 
      patients and study design. MCID is context-specific and potentially misguiding if 
      determined, applied or interpreted inappropriately. Explicit and conscientious 
      reflections on the choice of a reference value are required when using MCID to 
      classify research results as clinically important or trivial.
FAU - Olsen, Mette Frahm
AU  - Olsen MF
AUID- ORCID: 0000-0002-5742-6403
AD  - Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, Department 7811, 2100, 
      Copenhagen O, Denmark.
FAU - Bjerre, Eik
AU  - Bjerre E
AD  - University Hospitals' Centre for Health Research (UCSF), Rigshospitalet, 
      Blegdamsvej 9, Department 9701, 2100, Copenhagen O, Denmark.
FAU - Hansen, Maria Damkjaer
AU  - Hansen MD
AD  - Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
FAU - Hilden, Jorgen
AU  - Hilden J
AD  - Section of Biostatistics, University of Copenhagen, Ostre Farigmagsgade 5, 114, 
      Copenhagen O, Denmark.
FAU - Landler, Nino Emanuel
AU  - Landler NE
AD  - Department of Cardiology, Herlev-Gentofte Hospital, Kildegardsvej 28, 2900, 
      Hellerup, Denmark.
FAU - Tendal, Britta
AU  - Tendal B
AD  - Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, Department 7811, 2100, 
      Copenhagen O, Denmark.
FAU - Hrobjartsson, Asbjorn
AU  - Hrobjartsson A
AD  - Centre for Evidence-Based Medicine, University of Southern Denmark & Odense 
      University Hospital, Sdr. Boulevard 29, Gate 50 (Videncenteret), 5000, Odense C, 
      Denmark. Asbjorn.Hrobjartsson@rsyd.dk.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20170220
PL  - England
TA  - BMC Med
JT  - BMC medicine
JID - 101190723
SB  - IM
MH  - Acute Pain/*therapy
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Disability Evaluation
MH  - Humans
MH  - Middle Aged
MH  - Pain Management/*methods
MH  - Young Adult
PMC - PMC5317055
OTO - NOTNLM
OT  - Minimum clinically important difference
OT  - Pain
OT  - Systematic review
EDAT- 2017/02/22 06:00
MHDA- 2017/05/26 06:00
PMCR- 2017/02/20
CRDT- 2017/02/21 06:00
PHST- 2016/08/27 00:00 [received]
PHST- 2016/12/23 00:00 [accepted]
PHST- 2017/02/21 06:00 [entrez]
PHST- 2017/02/22 06:00 [pubmed]
PHST- 2017/05/26 06:00 [medline]
PHST- 2017/02/20 00:00 [pmc-release]
AID - 10.1186/s12916-016-0775-3 [pii]
AID - 775 [pii]
AID - 10.1186/s12916-016-0775-3 [doi]
PST - epublish
SO  - BMC Med. 2017 Feb 20;15(1):35. doi: 10.1186/s12916-016-0775-3.