PMID- 34699996
OWN - NLM
STAT- MEDLINE
DCOM- 20220329
LR  - 20220401
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 22
IP  - 4
DP  - 2022 Apr
TI  - Minimal clinically important difference in patients who underwent decompression 
      alone for lumbar degenerative disease.
PG  - 549-560
LID - S1529-9430(21)00970-0 [pii]
LID - 10.1016/j.spinee.2021.10.010 [doi]
AB  - BACKGROUND CONTEXT: The minimal clinically important difference (MCID) represents 
      the smallest change in an outcome measure recognized as clinically meaningful to 
      a patient after receiving a clinical intervention. Most studies that discussed 
      the MCIDs for lumbar spinal stenosis (LSS) included mixed pathologies or 
      procedures despite that the MCID value should be different depending on the 
      intervention. Moreover, despite the efficacy of adopting percentage-change 
      improvement for the MCID threshold, there are limited reports and discussions in 
      the field of lumbar surgery. PURPOSE: The aim of the present study was to 
      elucidate the MCIDs for the Oswestry Disability Index (ODI), EuroQOL 5-dimension 
      3-level (EQ-5D-3L), physical component summary (PCS) of the Short Form of the 
      Medical Outcomes Study, and Numeric Rating Scale (NRS) in patients with 
      degenerative LSS treated with decompression surgery without fusion. STUDY 
      DESIGN/SETTING: A multicenter retrospective cohort study was performed. PATIENT 
      SAMPLE: A total of 422 patients who underwent decompression surgery for LSS and 
      answered a complete set of questionnaires were included in the study. Patients 
      who underwent endoscopic or revision surgery were excluded. OUTCOME MEASURES: 
      Preoperative and 1-year postoperative scores of each health-related quality of 
      life questionnaires (HRQOLs) and patient satisfaction questionnaire response 
      METHODS: The patient satisfaction question was used as an anchor, and the cutoff 
      values were estimated based on absolute point improvement from baseline using a 
      receiver-operating characteristic (ROC) curve analysis and the "mean change" 
      method for MCIDs. The MCID values for percentage-change in HRQOLs were also 
      calculated using ROC curve analysis. The three cutoff values for each HRQOL were 
      validated using the Youden index for determining the most robust MCIDs. RESULTS: 
      Of the patients, 356 (84.4%) were at least "somewhat satisfied" with the 
      treatment results. The two cutoff values of absolute point-change in each HRQOL, 
      which were estimated by two different anchor-based methods, were similar. The 
      area under the curve of the ROC curve for percentage-change tended to be higher 
      than that for absolute point-change. Moreover, the Youden index of the 
      percentage-change in each HRQOL was higher than that of the absolute point-change 
      calculated by either the "mean change" method or the ROC curve analysis. Based on 
      these results, it was proposed that MCID was 42.4% for percentage-change in ODI, 
      22.0% for EQ-5D-3L, 13.7% for PCS, 25.0% for NRS (low back pain), 55.6% for NRS 
      (leg pain), 22.2% for NRS (leg numbness). CONCLUSIONS: The MCIDs of HRQOLs were 
      calculated in patients with LSS treated with decompression surgery without 
      concomitant fusion procedure. The MCID cutoffs based on percentage-change from 
      baseline were more effective than those of absolute point-change.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Nakarai, Hiroyuki
AU  - Nakarai H
AD  - Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 
      7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group 
      (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
FAU - Kato, So
AU  - Kato S
AD  - Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 
      7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group 
      (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan. Electronic address: 
      sokato@g.ecc.u-tokyo.ac.jp.
FAU - Kawamura, Naohiro
AU  - Kawamura N
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical 
      Center, 4-2, Hiroo, Shibuya-Ku, Tokyo 150-8935, Japan.
FAU - Higashikawa, Akiro
AU  - Higashikawa A
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Orthopedic Surgery, Kanto Rosai Hospital, 1-1, 
      Kizukisumiyoshi-Cho, Nakahaha-Ku, Kawasaki City, Kanagawa 211-8510, Japan.
FAU - Takeshita, Yujiro
AU  - Takeshita Y
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Orthopedic Surgery, Yokohama Rosai Hospital, 3211, 
      Kozukue-Cho, Kohoku-Ku, Yokohama City, Kanagawa 222-0036, Japan.
FAU - Fukushima, Masayoshi
AU  - Fukushima M
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Spine center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo 
      105-8470, Japan.
FAU - Ono, Takashi
AU  - Ono T
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Spinal Surgery, Japan Community Health-care Organization 
      Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, Tokyo 162-8543, 
      Japan.
FAU - Hara, Nobuhiro
AU  - Hara N
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 
      1-26-1, Kyonancho, Musashino City, Tokyo 180-0023, Japan.
FAU - Azuma, Seiichi
AU  - Azuma S
AD  - University of Tokyo Spine Group (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, 
      Japan; Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5, 
      Shintoshin, Chuo-Ku, Saitama City, Saitama 330-8553, Japan.
FAU - Tanaka, Sakae
AU  - Tanaka S
AD  - Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 
      7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
FAU - Oshima, Yasushi
AU  - Oshima Y
AD  - Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 
      7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan; University of Tokyo Spine Group 
      (UTSG), 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20211023
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Decompression
MH  - Disability Evaluation
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - *Minimal Clinically Important Difference
MH  - Pain Measurement/methods
MH  - *Quality of Life
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Degenerative lumbar spinal stenosis
OT  - EQ-5D
OT  - Lumbar decompression surgery
OT  - Minimal clinically important difference
OT  - NRS
OT  - ODI
OT  - SF-12
OT  - Satisfaction
OT  - Spine surgery
OT  - percentage
COIS- Declarations of Competing Interests The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2021/10/27 06:00
MHDA- 2022/03/30 06:00
CRDT- 2021/10/26 20:15
PHST- 2021/03/29 00:00 [received]
PHST- 2021/08/22 00:00 [revised]
PHST- 2021/10/12 00:00 [accepted]
PHST- 2021/10/27 06:00 [pubmed]
PHST- 2022/03/30 06:00 [medline]
PHST- 2021/10/26 20:15 [entrez]
AID - S1529-9430(21)00970-0 [pii]
AID - 10.1016/j.spinee.2021.10.010 [doi]
PST - ppublish
SO  - Spine J. 2022 Apr;22(4):549-560. doi: 10.1016/j.spinee.2021.10.010. Epub 2021 Oct 
      23.