Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

What is an acceptable outcome of treatment before it begins? Methodological considerations and implications for patients with chronic low back pain

What is an acceptable outcome of treatment before it begins? Methodological considerations and... Understanding changes in patient-reported outcomes is indispensable for interpretation of results from clinical studies. As a consequence the term “minimal clinically important difference” (MCID) was coined in the late 1980s to ease classification of patients into improved, not changed or deteriorated. Several methodological categories have been developed determining the MCID, however, all are subject to weaknesses or biases reducing the validity of the reported MCID. The objective of this study was to determine the reproducibility and validity of a novel method for estimating low back pain (LBP) patients’ view of an acceptable change (MCID pre ) before treatment begins. One-hundred and forty-seven patients with chronic LBP were recruited from an out-patient hospital back pain unit and followed over an 8-week period. Original and modified versions of the Oswestry disability index (ODI), Bournemouth questionnaire (BQ) and numeric pain rating scale (NRS pain ) were filled in at baseline. The modified questionnaires determined what the patient considered an acceptable post-treatment outcome which allowed us to calculate the MCID pre . Concurrent comparisons between the MCID pre , instrument measurement error and a retrospective approach of establishing the minimal clinically important difference (MCID post ) were made. The results showed the prospective acceptable outcome method scores to have acceptable reproducibility outside measurement error. MCID pre was 4.5 larger for the ODI and 1.5 times larger for BQ and NRS pain compared to the MCID post . Furthermore, MCID pre and patients post-treatment acceptable change was almost equal for the NRS pain but not for the ODI and BQ. In conclusion, chronic LBP patients have a reasonably realistic idea of an acceptable change in pain, but probably an overly optimistic view of changes in functional and psychological/affective domains before treatment begins. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Spine Journal Springer Journals

What is an acceptable outcome of treatment before it begins? Methodological considerations and implications for patients with chronic low back pain

Download PDF
9 pages

Loading next page...
 
/lp/springer-journals/what-is-an-acceptable-outcome-of-treatment-before-it-begins-R9sz3zD6UG

References (49)

Publisher
Springer Journals
Copyright
Copyright © 2009 by Springer-Verlag
Subject
Medicine & Public Health; Neurosurgery ; Surgical Orthopedics
ISSN
0940-6719
eISSN
1432-0932
DOI
10.1007/s00586-009-1070-1
pmid
19544075
Publisher site
See Article on Publisher Site

Abstract

Understanding changes in patient-reported outcomes is indispensable for interpretation of results from clinical studies. As a consequence the term “minimal clinically important difference” (MCID) was coined in the late 1980s to ease classification of patients into improved, not changed or deteriorated. Several methodological categories have been developed determining the MCID, however, all are subject to weaknesses or biases reducing the validity of the reported MCID. The objective of this study was to determine the reproducibility and validity of a novel method for estimating low back pain (LBP) patients’ view of an acceptable change (MCID pre ) before treatment begins. One-hundred and forty-seven patients with chronic LBP were recruited from an out-patient hospital back pain unit and followed over an 8-week period. Original and modified versions of the Oswestry disability index (ODI), Bournemouth questionnaire (BQ) and numeric pain rating scale (NRS pain ) were filled in at baseline. The modified questionnaires determined what the patient considered an acceptable post-treatment outcome which allowed us to calculate the MCID pre . Concurrent comparisons between the MCID pre , instrument measurement error and a retrospective approach of establishing the minimal clinically important difference (MCID post ) were made. The results showed the prospective acceptable outcome method scores to have acceptable reproducibility outside measurement error. MCID pre was 4.5 larger for the ODI and 1.5 times larger for BQ and NRS pain compared to the MCID post . Furthermore, MCID pre and patients post-treatment acceptable change was almost equal for the NRS pain but not for the ODI and BQ. In conclusion, chronic LBP patients have a reasonably realistic idea of an acceptable change in pain, but probably an overly optimistic view of changes in functional and psychological/affective domains before treatment begins.

Journal

European Spine Journal – Springer Journals

Published: Dec 1, 2009

There are no references for this article.