应用最小临床意义差异的挑战:评论性综述。

IF 1.5 4区 医学 Q3 REHABILITATION International Journal of Rehabilitation Research Pub Date : 2024-03-01 Epub Date: 2024-01-22 DOI:10.1097/MRR.0000000000000613
Joseph Podurgiel, Daniele Piscitelli, Craig Denegar
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引用次数: 0

摘要

医疗保健临床医生努力使患者的功能和参与发生有意义的改变。最小临床意义差异(MCID)是对患者所需的有意义改变的估计值。临床医生和研究人员可能会认为,所引用的 MCID 是有效且可推广的效果估计值。然而,这一假设至少存在两个问题。首先,计算 MCID 的方法有多种,可能会产生不同的值,并使人对应用哪种方法产生怀疑。其次,MCID 值可能会被错误地推广到健康状况不同的患者身上。有鉴于此,我们回顾了用于计算 MCID 的方法以及神经科、骨科和老年病科常用结果测量的 MCID 值的引用报告。我们的目标是评估引用文献中是否承认了计算方法,以及入组患者是否与得出 MCID 估计值的样本相似。我们发现估算 MCID 的方法存在令人担忧的差异。我们还发现,引用文献在确定计算方法和适用健康状况方面缺乏透明度。因此,临床医生和研究人员在假定患者状态的变化超过特定的 MCID 时,必须密切关注并谨慎行事,因为这种变化反映了健康状况的有意义改善。需要制定一个计算和报告 MCID 的通用标准,以解决通过解释 MCID 得出的结论的有效性所面临的威胁。
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Challenges in applying minimal clinically important difference: a critical review.

Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
88
审稿时长
6-12 weeks
期刊介绍: International Journal of Rehabilitation Research is a quarterly, peer-reviewed, interdisciplinary forum for the publication of research into functioning, disability and contextual factors experienced by persons of all ages in both developed and developing societies. The wealth of information offered makes the journal a valuable resource for researchers, practitioners, and administrators in such fields as rehabilitation medicine, outcome measurement nursing, social and vocational rehabilitation/case management, return to work, special education, social policy, social work and social welfare, sociology, psychology, psychiatry assistive technology and environmental factors/disability. Areas of interest include functioning and disablement throughout the life cycle; rehabilitation programmes for persons with physical, sensory, mental and developmental disabilities; measurement of functioning and disability; special education and vocational rehabilitation; equipment access and transportation; information technology; independent living; consumer, legal, economic and sociopolitical aspects of functioning, disability and contextual factors.
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