Beyond Minimally Important Change
Bibliographic record
Abstract
STUDY DESIGN: Prospective, longitudinal cohort study OBJECTIVE: To examine the validity of a threshold that has been used to define a successful outcome for patients with low back pain (LBP), undergoing nonsurgical rehabilitation based on a 50% improvement on the Modified Oswestry disability index (ODI). SUMMARY OF BACKGROUND DATA: Making research findings interpretable is a goal of evidence-based practice. One attempt to improve interpretability is reporting treatment results as the percentage of patients achieving a threshold level of improvement within treatment groups along with mean between-group differences. The most recommended threshold is the minimum clinically important difference of the outcome tool. For clinical conditions with favorable natural histories such as LBP, thresholds requiring more than minimal improvement may be preferable for defining success. METHODS: Patients with LBP receiving 4 weeks of physical therapy were examined. The ODI and measures of pain, fear-avoidance beliefs, and demographic characteristics were recorded at baseline and after treatment. A 15-point global rating of change was also completed after treatment. The percent ODI change with treatment was computed and compared between groups known to have different prognoses. The percent ODI change was compared to the global rating of change to determine the accuracy of various thresholds of success based on the percent ODI change. RESULTS: A total of 243 subjects (mean age 37.2 +/- 11.4 years, 44.9% female) were included. Mean percent ODI change was 43.1% (+/-40.5), and 109 subjects (44.9%) had a successful outcome (>or=50% ODI improvement). As hypothesized, baseline factors with known prognostic importance were less likely to be present in subjects with a successful outcome. The 50% ODI improvement threshold for success had high sensitivity (0.84; 95% CI: 0.79, 0.88) and specificity (0.89; 95% CI: 0.85, 0.93) when compared with success based on the global rating of change. No other percent improvement threshold for the ODI had a higher accuracy than the 50% threshold when compared to the global rating of change. CONCLUSION: A threshold of 50% improvement on the ODI may be a valid measure for defining a successful outcome for patients with LBP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.065 | 0.158 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".