Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part II: Lower Extremity
Notice bibliographique
Résumé
Background: The minimum clinically important difference (MCID) attempts to define the patient’s experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of the MCID calculation, so as to help practitioners to understand and utilize the MCID and to guide future efforts to calculate the MCID. In Part I of this review, we sampled the orthopaedic literature in relation to the upper extremity. In this part, Part II, of the review, we will focus on the lower-extremity literature. Methods: A review was conducted of the 2014 to 2016 MCID-related publications in The Journal of Arthroplasty, The Journal of Bone & Joint Surgery, The American Journal of Sports Medicine, Foot & Ankle International, Journal of Orthopaedic Trauma, Journal of Pediatric Orthopaedics, and Journal of Shoulder and Elbow Surgery. Only clinical science articles utilizing patient-reported outcome measures (PROMs) were included in the analysis. A keyword search was then performed to identify articles that used the MCID. Articles were then further categorized into upper-extremity and lower-extremity publications. The MCID utilization in the selected articles was characterized and was recorded. Results: The MCID was referenced in 129 (7.5%) of 1,709 clinical science articles that utilized PROMs: 79 (61.2%) of the 129 articles were related to the lower extremity; of these, 11 (13.9%) independently calculated the MCID values and 68 (86.1%) used previously published MCID values as a gauge of their own results. The MCID values were calculated or were considered for 31 PROMs, of which 24 were specific to the lower extremity. Eleven different methods were used to calculate the MCID. The MCID had a wide range of values for the same questionnaires, for instance, 5.8 to 31.3 points for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Conclusions: There are more than twice as many PROMs for the lower extremity (24) than for the upper extremity (11), confirming that the determination of useful MCID values is, in part, hampered by the proliferation of PROMs in the field of orthopaedics. The difference between significance and clinical importance needs to be further clarified. For instance, the common use of determining sample size with the MCID and comparing group means with the MCID implies that a significant result will also be clinically important. Further, the study of the MCID would benefit from consensus agreement on relevant terminology and the appropriate usage of the MCID determining equations. Clinical Relevance: MCID is increasingly used as a measure of patients’ improvement. However, MCID does not yet adequately capture the clinical importance of patients’ improvement.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,022 | 0,105 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,043 | 0,040 |
| Études des sciences et des technologies | 0,001 | 0,003 |
| Communication savante | 0,006 | 0,008 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».