Abstract
Background: The Minimal Clinically Important Difference (MCID) quantifies when measured differences can be considered clinically relevant. This study aims to review and triangulate MCIDs of COPD health status tools.
Methods: A systematic search in PubMed, EMBASE and Cochrane Library was conducted (Prospero #CRD42015023221). Study details, patient characteristics, MCID methodology and estimates were assessed and extracted by two authors. MCIDs were triangulated by weighing: 2/3 anchor-based and 1/3 distribution-based results, the size and quality rating of the included studies.
Results: Overall, 785 records were reviewed of which 21 studies were included for analysis. MCIDs of 12 tools were presented. General quality and risk of bias was average to good. Triangulated MCIDs for CAT, CCQ, and SGRQ were −2.54, −0.43 and −7.43 for improvement. Too few and/or too diverse studies were present to triangulate MCIDs of other tools.
Conclusions: Evidence for the MCID of the CAT and CCQ was strong and triangulation seemed valid. Currently used MCIDs in clinical practice for SGRQ (4) and CRQ (0.5) did not match the reviewed content, which turned out much higher. Using too low MCIDs may lead to overestimation of the interpretation of treatment effects. MCIDs for deterioration were scarce and highlights need for more research.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. de Jong has nothing to disclose.
Conflict of interest: Dr. Tsiligianni reports personal fees from BI, GSK, Novartis, outside the submitted work.
Conflict of interest: Dr. Sanderman has nothing to disclose.
Conflict of interest: Dr. Kocks reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants from Chiesi, grants and personal fees from GSK, grants and personal fees from Novartis, grants from Mundi Pharma, grants from TEVA, outside the submitted work.
Conflict of interest: Dr. van der Molen reports other from GSK, outside the submitted work; In addition, Dr. van der Molen has a patent CCQ copyrights with royalties paid.
Competing interests: Harma Alma, Corina de Jong and Robbert Sanderman have nothing to disclose. Janwillem Kocks reports personal fees from Novartis; research grants and personal fees from Boehringer Ingelheim; research grants and personal fees from GSK; research grants from Stichting Zorgdraad; personal fees from IPCRG; personal fees from Springer Media; and travel arrangements from Chiesi BV, GlaxoSmithKline BV, and IPCRG; all outside the submitted work. Ioanna Tsiligianni received personal fees from Boehringer Ingelheim, Novartis, AstraZeneca and GlaxoSmithKline; all outside the submitted work. Thys van der Molen reports personal reimbursements from GSK, TEVA, Astra Zeneca, Boehringer Ingelheim, and study grants from Astra Zeneca and GSK. This was all outside the submitted work. After this study was terminated, he became an employee of GSK. Thys van der Molen developed the CCQ and holds the copyright.
Conflict of interest: Dr. Alma has nothing to disclose.
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