The minimal important difference: Who's to say what is important?

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    In contrast to the noted case reports, our cohort study additionally used the MCID of EDSS and BBS to interpret efficacy. The MCID of an instrument can be used to determine whether the change scores indicate true and meaningful changes in follow-up or outcome studies (Wright 1996; Beaton et al. 2002). Our results showed that the percentage of EDSS change reaching MCID was 90% (9/10) in the subgroup with EDSS 4.5–6.0 and 100% (26/26) in the subgroup with EDSS 6.5–10.0 in RG, which was significantly higher (P<0.05) compared with CG.

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    In addition, two recent randomized controlled trials used the RSI and found that PPIs were more effective than the placebo [6,7]. Although a disease-specific instrument can be used to measure PRO, a statistically significant score change may not be clinically relevant [13]. Subsequently, minimally important differences, defined as the smallest meaningful difference derived from point estimates of mean differences among groups, may mask important changes for individuals [14].

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    This eight-item, valid, reliable tool can be used for evaluative or discriminatory assessments.15,23 The MCID is the smallest difference in score that can be detected or noticed within a homogenous patient group24 and is intended to help drive clinical decisions related to program development, such as initiating or discontinuing a particular treatment strategy. Both anchor and distribution-based methods have been used to establish an MCID, although estimates using different methodologies often are disparate.

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