Contemporary Analysis of Minimal Clinically Important Difference in the Neurosurgical Literature

• Published in: Neurosurgery Vol. 88; no. 4; pp. 713 - 719
• Main Authors: Zervos, Thomas M, Asmaro, Karam, Air, Ellen L
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-04-2021; Wolters Kluwer Health, Inc
• Subjects: Adult; Back pain; Care and treatment; Clinical outcomes; Cost benefit analysis; Female; Humans; Intervention; Male; Middle Aged; Minimal Clinically Important Difference; Neurosurgery; Neurosurgical Procedures - standards; Neurosurgical Procedures - trends; Outcome Assessment, Health Care - standards; Outcome Assessment, Health Care - trends; Pain; Pain Measurement - standards; Pain Measurement - trends; Patients; Quality of life; Quality of Life - psychology; Questionnaires; Spinal cord; Statistical significance; Treatment Outcome; Statistical significance; Health-related quality of life; Outcome measures; Patient-reported outcomes; Clinimetrics; Minimal clinically important difference; Quality of life
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa490

Abstract
BACKGROUND
Minimal clinically important difference (MCID) is determined when a patient or physician defines the minimal change that outweighs the costs and untoward effects of a treatment. These measurements are “anchored” to validated quality-of-life instruments or physician-rated, disease-activity indices. To capture the subjective clinical experience in a measurable way, there is an increasing use of MCID.
OBJECTIVE
To review the overall concept, method of calculation, strengths, and weaknesses of MCID and its application in the neurosurgical literature.
METHODS
Recent articles were reviewed based on PubMed query. To illustrate the strengths and limitations of MCID, studies regarding the measurement of pain are emphasized and their impact on subsequent publications queried.
RESULTS
MCID varies by population baseline characteristics and calculation method. In the context of pain, MCID varied based on the quality of pain, chronicity, and treatment options.
CONCLUSION
MCID evaluates outcomes relative to whether they provide a meaningful change to patients, incorporating the risks and benefits of a treatment. Using MCID in the process of evaluating outcomes helps to avoid the error of interpreting a small but statistically significant outcome difference as being clinically important.