PMID- 38219130 OWN - NLM STAT- MEDLINE DCOM- 20240319 LR - 20240319 IS - 1526-3231 (Electronic) IS - 0749-8063 (Linking) VI - 40 IP - 4 DP - 2024 Apr TI - Editorial Commentary: The Minimal Clinically Important Difference Is Less Important Than It Sounds: Patients Seek to Achieve Substantial Clinical Benefits and Not Minimally Perceptible Improvements When They Undergo Arthroscopic Surgery. PG - 1089-1092 LID - S0749-8063(23)00858-7 [pii] LID - 10.1016/j.arthro.2023.10.014 [doi] AB - The minimal clinically important difference (MCID) is a frequently reported metric for describing within-patient improvement in patient-reported outcome measures (PROMs). It was originally defined by Jaeschke et al. as "the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient's management." The latter part of this statement is often omitted, and this results in a loss of the originally intended value through lack of sufficient clinical importance to change management. Other pitfalls in the use of the MCID include that they are population- and condition-specific. As such, MCIDs lack external validity and cannot easily be extrapolated from one study to another. Furthermore, broadly different values can be obtained depending on the calculation method used. This makes the MCID an unhelpful metric when seeking to understand the true efficacy of a given intervention. The Food and Drug Administration recommends anchor-based methodologies (which take into account patient perception), over distribution-based methods (which are purely statistical and do not account for clinical meaningfulness to patients). Regardless, it should be noted that even anchor-based methodologies are susceptible to statistical bias, and measures are apt to be influenced by the regression to mean phenomena, where the value of the preintervention scores and their relationship to postintervention scores can bias estimates of the MCID. Finally, when using MCIDs, one must consider that they are a low bar. This means that patients do not undergo treatment to achieve minimally perceptible clinical improvements; instead, they undergo treatment with the hope of achieving substantial clinical benefit or a patient acceptable symptom state, and so these are more appropriate individual-level metrics to consider when evaluating clinically meaningful outcomes of treatment. CI - Copyright (c) 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. FAU - Saithna, Adnan AU - Saithna A FAU - Cote, Mark P AU - Cote MP LA - eng PT - Editorial DEP - 20240111 PL - United States TA - Arthroscopy JT - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JID - 8506498 SB - IM MH - Humans MH - *Arthroscopy MH - *Minimal Clinically Important Difference MH - Treatment Outcome MH - Patient Reported Outcome Measures MH - Pain Measurement COIS- Disclosure The authors report the following potential conflicts of interest or sources of funding: A.S. reports grants or contracts and support for attending meetings and/or travel from AANA; consulting fees from Arthrex; and leadership or fiduciary role in other board, society, committee or, advocacy group, paid or unpaid: AANA (Associate Editor, Arthroscopy, and committees), American Journal of Sports Medicine and Orthopaedic Journal of Sports Medicine editorial boards, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Committee, and SANTI Study Group. M.C. reports Associate Editor, Arthroscopy. Full ICMJE author disclosure forms are available for this article online, as supplementary material. EDAT- 2024/01/14 14:42 MHDA- 2024/03/19 06:44 CRDT- 2024/01/14 10:34 PHST- 2023/10/12 00:00 [received] PHST- 2023/10/18 00:00 [revised] PHST- 2023/10/19 00:00 [accepted] PHST- 2024/03/19 06:44 [medline] PHST- 2024/01/14 14:42 [pubmed] PHST- 2024/01/14 10:34 [entrez] AID - S0749-8063(23)00858-7 [pii] AID - 10.1016/j.arthro.2023.10.014 [doi] PST - ppublish SO - Arthroscopy. 2024 Apr;40(4):1089-1092. doi: 10.1016/j.arthro.2023.10.014. Epub 2024 Jan 11.