Detecting change in community participation with the Enfranchisement scale of the community participation indicators

2021 ◽  
pp. 026921552110521
Author(s):  
Jessica Kersey ◽  
Lauren Terhorst ◽  
Joy Hammel ◽  
Carolyn Baum ◽  
Joan Toglia ◽  
...  
Keyword(s):  
Community Participation ◽  
Functional Independence Measure ◽  
Minimum Clinically Important Difference ◽  
Functional Independence ◽  
Baseline Score ◽  
Sensitivity To Change ◽  
Detectable Change ◽  
Change Scores ◽  
Minimum Detectable Change ◽  
Clinically Important Difference

Objective This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. Data sources We analyzed data from two studies of participants with stroke: an intervention study and an observational study. Main measures The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14–70) and the Control subscale (choice and control: range: 13–64). Data analysis Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. Results The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. Conclusions The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.

Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance

2012 ◽  
Vol 16 (5) ◽  
pp. 471-478 ◽  
Author(s):  
Scott L. Parker ◽  
Stephen K. Mendenhall ◽  
David N. Shau ◽  
Owoicho Adogwa ◽  
William N. Anderson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimum Clinically Important Difference ◽  
Leg Pain ◽  
Lumbar Stenosis ◽  
Detectable Change ◽  
Calculation Methods ◽  
Recurrent Stenosis ◽  
Minimum Detectable Change ◽  
Clinically Important Difference

Object Spine surgery outcome studies rely on patient-reported outcome (PRO) measurements to assess treatment effect, but the extent of improvement in the numerical scores of these questionnaires lacks a direct clinical meaning. Because of this, the concept of a minimum clinically important difference (MCID) has been used to measure the critical threshold needed to achieve clinically relevant treatment effectiveness. As utilization of spinal fusion has increased over the past decade, so has the incidence of same-level recurrent stenosis following index lumbar fusion, which commonly requires revision decompression and fusion. The MCID remains uninvestigated for any PROs in the setting of revision lumbar surgery for this pathology. Methods In 53 consecutive patients undergoing revision surgery for same-level recurrent lumbar stenosis–associated back and leg pain, PRO measures of back and leg pain were assessed preoperatively and 2 years postoperatively, using the visual analog scale for back pain (VAS-BP) and leg pain (VAS-LP), Oswestry Disability Index (ODI), Physical and Mental Component Summary categories of the 12-Item Short Form Health Survey (SF-12 PCS and MCS) for quality of life, Zung Depression Scale (ZDS), and EuroQol-5D health survey (EQ-5D). Four established anchor-based MCID calculation methods were used to calculate MCID (average change; minimum detectable change; change difference; and receiver operating characteristic curve analysis) for 2 separate anchors (health transition index of the SF-36 and the satisfaction index). Results All patients were available for 2-year PRO assessment. Two years after surgery, a significant improvement was observed for all PROs assessed. The 4 MCID calculation methods generated a range of MCID values for each of the PROs (VAS-BP 2.2–6.0, VAS-LP 3.9–7.5, ODI 8.2–19.9, SF-12 PCS 2.5–12.1, SF-12 MCS 7.0–15.9, ZDS 3.0–18.6, and EQ-5D 0.29–0.52). Each patient answered synchronously for the 2 anchors, suggesting both of these anchors are equally appropriate and valid for this patient population. Conclusions The same-level recurrent stenosis surgery-specific MCID is highly variable based on calculation technique. The “minimum detectable change” approach is the most appropriate method for calculation of MCIDs in this population because it was the only method to reliably provide a threshold above the 95% confidence interval of the unimproved cohort (greater than the measurement error). Based on this method, the MCID thresholds following neural decompression and fusion for symptomatic same-level recurrent stenosis are 2.2 points for VAS-BP, 5.0 points for VAS-LP, 8.2 points for ODI, 2.5 points for SF-12 PCS, 10.1 points for SF-12 MCS, 4.9 points for ZDS, and 0.39 QALYs for EQ-5D.

Differentiating minimum clinically important difference for primary and revision lumbar fusion surgeries

2013 ◽  
Vol 18 (1) ◽  
pp. 102-106 ◽  
Author(s):  
Leah Y. Carreon ◽  
Kelly R. Bratcher ◽  
Chelsea E. Canan ◽  
Lauren O. Burke ◽  
Mladen Djurasovic ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Improvement ◽  
Lumbar Fusion ◽  
Minimum Clinically Important Difference ◽  
Leg Pain ◽  
Detectable Change ◽  
Minimum Detectable Change ◽  
Clinically Important Difference ◽  
Sf 36 ◽  
Patient Reported

Object Previous studies have reported on the minimum clinically important difference (MCID), a threshold of improvement that is clinically relevant for lumbar degenerative disorders. Recent studies have shown that pre- and postoperative health-related quality of life (HRQOL) measures vary among patients with different diagnostic etiologies. There is also concern that a patient's previous care experience may affect his or her perception of clinical improvement. This study determined if MCID values for the Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36), and back and leg pain are different between patients undergoing primary or revision lumbar fusion. Methods Prospectively collected preoperative and 1-year postoperative patient-reported HRQOLs, including the ODI, SF-36 physical component summary (PCS), and numeric rating scales (0–10) for back and leg pain, in patients undergoing lumbar spine fusion were analyzed. Patients were grouped into either the primary surgery or revision group. As the most widely accepted MCID values were calculated from the minimum detectable change, this method was used to determine the MCID. Results A total of 722 patients underwent primary procedures and 333 patients underwent revisions. There was no statistically significant difference in demographics between the groups. Each group had a statistically significant improvement at 1 year postoperatively compared with baseline. The minimum detectable change–derived MCID values for the primary group were 1.16 for back pain, 1.36 for leg pain, 12.40 for ODI, and 5.21 for SF-36 PCS. The MCID values for the revision group were 1.21 for back pain, 1.28 for leg pain, 11.79 for ODI, and 4.90 for SF-36 PCS. These values are very similar to those previously reported in the literature. Conclusions The MCID values were similar for the revision and primary lumbar fusion groups, even when subgroup analysis was done for different diagnostic etiologies, simplifying interpretation of clinical improvement. The results of this study further validate the use of patient-reported HRQOLs to measure clinical effectiveness, as a patient's previous experience with care does not seem to substantially alter an individual's perception of clinical improvement.

scholarly journals Percutaneous Stereotactic Radiofrequency Lesioning for Trigeminal Neuralgia

Neurosurgery ◽  
2013 ◽  
Vol 74 (3) ◽  
pp. 262-266 ◽  
Author(s):  
Vishruth K. Reddy ◽  
Scott L. Parker ◽  
Dennis T. Lockney ◽  
Samit A. Patrawala ◽  
Pei-Fang Su ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Effectiveness ◽  
Characteristic Curve ◽  
Minimum Clinically Important Difference ◽  
Health Transition ◽  
Detectable Change ◽  
Minimum Detectable Change ◽  
Clinically Important Difference ◽  
Patient Reported ◽  
Transition Index

Abstract BACKGROUND: The Visual Analog Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNI-PS) are 2 patient-reported outcome (PRO) tools frequently used to rate pain from trigeminal neuralgia (TN). Outcomes studies often use these patient-reported outcomes to assess treatment effectiveness, but it is unknown exactly what degree of change in the numerical scores constitutes the minimum clinically important difference (MCID). MCID remains uninvestigated for percutaneous stereotactic radiofrequency lesioning (RFL), a common surgical procedure for TN. OBJECTIVE: To determine MCID values for the VAS and BNI-PS in patients undergoing RFL. METHODS: Forty-three consecutive patients with TN who underwent RFL by a single surgeon were prospectively assessed with the VAS and BNI-PS preoperatively and 3 years postoperatively. Three anchors were used to assign each patient's outcome: satisfaction, willingness to have the surgery again, and Health Transition Index. We then used 3 well-established, anchor-based methods to calculate MCID: average change, minimum detectable change, and change difference. RESULTS: Patients experienced substantial improvement in both VAS (9.81 vs 3.35; P < .001) and BNI-PS (4.95 vs 2.44; P < .001) after RFL. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS, 4.13-8.20; BNI-PS, 1.03-3.30). The area under the receiver-operating characteristic curve was greater for BNI-PS compared with VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. CONCLUSION: RFL-specific MCID is variable on the basis of the calculation technique. With the use of the minimum detectable change calculation method with the Health Transition Index anchor, the minimum clinically important difference is 4.49 for VAS and 1.16 for BNI-PS after RFL for TN.

Less-Affected Hand Function Is Associated With Independence in Daily Living: A Longitudinal Study Poststroke

Stroke ◽  
2021 ◽  
Author(s):  
Samar Hmaied Assadi ◽  
Haim Barel ◽  
Israel Dudkiewicz ◽  
Revital Feige Gross-Nevo ◽  
Debbie Rand
Keyword(s):  
Grip Strength ◽  
Daily Living ◽  
Minimal Clinically Important Difference ◽  
Hand Function ◽  
Brain Lesion ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Clinically Important Difference ◽  
Stroke Type ◽  
Block Test

Background and Purpose: The upper extremity (UE) ipsilateral to the brain lesion is mildly affected poststroke. It is unclear whether patients perceive this, and the association between less-affected hand function and independence in activities of daily living (ADL) is unknown. We aimed to (1) assess longitudinal changes in function, dexterity, grip strength, and self-perception of the less-affected UE, (2) compare them to the normative data, and (3) determine the association of both UEs to ADL during the first 6 months poststroke. Methods: Consecutive adults following a first stroke were assessed on rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) poststroke onset. Box and block test assessed function of both UEs. The functional dexterity test (FDT) and Jamar Dynamometer assessed dexterity and grip strength of the less-affected UE. The functional independence measure assessed ADL, and instrumental ADL was assessed at T3. Spearman correlations and multiple regression models were used. Results: Participants were assessed at T1 (N=87), T2 (N=82), and T3 (N=68). At T1, less-affected UE deficits were apparent (median [interquartile range] box and block test-45 [35–53] blocks, FDT-44.5 [33.3–60.8] seconds, grip-25.5 [16.2–33.9] kilograms), but only 19.5% of the participants self-perceived this. Less-affected hand function significantly improved with 32% and 33% achieving a minimal clinically important difference for box and block test at T2 and T3, respectively. Dexterity improved significantly between T1 and T2 ( P <0.001, no established minimal clinically important difference) and grip strength improved significantly between T2 and T3; 3.4% achieving a minimal clinically important difference ( P <0.01). At T3, most participants did not reach the norms (box and block test-67.4 blocks, FDT-32.2 seconds, grip-40.5 kilograms). Both the less- and more-affected UEs explained a large portion of the variance of ADL at all time-points, after controlling for age, days-since-stroke-onset, stroke type, and cognition. Conclusions: Despite some improvement, the less-affected UE at 6 months poststroke remained below norms, explaining difficulties in ADL and instrumental ADL. Further research is needed.

scholarly journals Assessment of the Minimum Clinically Important Difference in the Timed Up and Go Test After Surgery for Lumbar Degenerative Disc Disease

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Oliver P. Gautschi ◽  
Martin N. Stienen ◽  
Marco V. Corniola ◽  
Holger Joswig ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Oswestry Disability Index ◽  
Short Form ◽  
Minimum Clinically Important Difference ◽  
Leg Pain ◽  
Analog Scale ◽  
Disc Disease ◽  
Timed Up And Go ◽  
Minimum Detectable Change ◽  
Clinically Important Difference ◽  
Euroqol 5D

Abstract BACKGROUND: The Timed Up and Go Test (TUG Test) has previously been described as a reliable tool to evaluate objective functional impairment in patients with degenerative disc disease. OBJECTIVE: The aim of this study was to assess the minimum clinically important difference (MCID) of the TUG Test. METHODS: The TUG Test (measured in seconds) was correlated with validated patient-reported outcome measures (PROs) of pain intensity (Visual Analog Scale for back and leg pain), functional impairment (Oswestry Disability Index, Roland Morris Disability Index), and health-related quality of life measures (Short Form-12 and EuroQol 5D). Three established methods were used to establish anchor-based MCID values using responders of the following PROs (Visual Analog Scale back and leg pain, Oswestry Disability Index, Roland Morris Disability Index, EuroQol 5D index, and Short Form-12 Physical Component Summary) as anchors: (1) average change, (2) minimum detectable change, and (3) change difference approach. RESULTS: One hundred patients with a mean ± SD age of 56.2 ± 16.1 years, 57 (57%) male, 45 patients undergoing microdiscectomy, 35 undergoing lumbar decompression, and 20 undergoing fusion surgery were studied. The 3 MCID computation methods revealed a range of MCID values according to the PRO used from 0.9 s (Oswestry Disability Index based on the change difference approach) to 6.0 s (EuroQol 5D index based on the minimum detectable change approach), with a mean MCID of 3.4 s for all measured PROs. CONCLUSION: The MCID for the TUG Test time is highly variable depending on the computation technique used. The average TUG Test MCID was 3.4 s using all 3 methods and all anchors.

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