ObjectiveTo estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale.DesignData from a cluster-randomized clinical trial and a cohort study.SettingGeneral practices in the Netherlands.Participants3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years.MeasurementsAt baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method.ResultsAnchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed.ConclusionThe MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.
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Background: Previous studies found that 40-60% of the sarcoidosis patients suffer from small fiber neuropathy (SFN), substantially affecting quality of life. SFN is difficult to diagnose, as a gold standard is still lacking. The need for an easily administered screening instrument to identify sarcoidosis-associated SFN symptoms led to the development of the SFN Screening List (SFNSL). The usefulness of any questionnaire in clinical management and research trials depends on its interpretability. Obtaining a clinically relevant change score on a questionnaire requires that the smallest detectable change (SDC) and minimal important difference (MID) are known. Objectives: The aim of this study was to determine the SDC and MID for the SFNSL in patients with sarcoidosis. Methods: Patients with neurosarcoidosis and/or sarcoidosis-associated SFN symptoms (N=138) included in the online Dutch Neurosarcoidosis Registry participated in a prospective, longitudinal study. Anchor-based and distribution-based methods were used to estimate the MID and SDC, respectively. Results: The SFNSL was completed both at baseline and at 6-months’ follow-up by 89/138 patients. A marginal ROC curve (0.6) indicated cut-off values of 3.5 points, with 73% sensitivity and 49% specificity for change. The SDC was 11.8 points. Conclusions: The MID on the SFNSL is 3.5 points for a clinically relevant change over a 6-month period. The MID can be used in the follow-up and management of SFN-associated symptoms in patients with sarcoidosis, though with some caution as the SDC was found to be higher.
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CC-BY-NC-NDSTUDY DESIGN:prospective cohort study.OBJECTIVE:To analyze responsiveness and minimal clinically important change (MCIC) of the US National Institutes of Health (NIH) minimal dataset for chronic low back pain (CLBP).SUMMARY OF BACKGROUND DATA:The NIH minimal dataset is a 40-item questionnaire developed to increase use of standardized definitions and measures for CLBP. Longitudinal validity of the total minimal dataset and the subscale Impact Stratification are unknown.METHODS:Total outcome scores on the NIH minimal dataset, Dutch Language Version, were calculated ranging from 0-100 points with higher scores representing worse functioning. Responsiveness and MCIC were determined with an anchor based method, calculating the area under the receiver operating characteristics (ROC) curve (AUC) and by determining the optimal cut-off point. Smallest detectable change (SDC) was calculated as a parameter of measurement error.RESULTS:In total 223 patients with CLBP were included. Mean total score on the NIH minimal dataset was 44 ± 14 points at baseline. The total outcome score was responsive to change with an AUC of 0.84. MCIC was 14 points with a sensitivity of 72% and specificity 82%, and SDC was 23 points. Mean total score on Impact Stratification (scale 8-50) was 34.4 ± 7.4 points at baseline, with an AUC of 0.91, an MCIC of 7.5 with a sensitivity 96% of and specificity of 78%, and an SDC of 14 points.CONCLUSION:The longitudinal validity of the NIH minimal dataset is adequate. An improvement of 14 points in total outcome score and 7.5 points in Impact Stratification can be interpreted as clinically important in individual patients. However, MCIC depends on baseline values and the method that is chosen to determine the optimal cut-off point. Furthermore, measurement error is larger than the MCIC. This means that individual change scores should be interpreted with caution.LEVEL OF EVIDENCE:4This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal
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Vragenlijsten die fysiotherapeuten gebruiken om behandeluitkomsten te meten zijn vaak lang en bevatten soms irrelevante vragen. Dit probleem kan opgelost worden door gebruik te maken van PROMIS-CAT (Computer Adaptief Testen). Door deze slimme manier van meten hoeven nog maar vier tot zeven vragen ingevuld te worden voor een betrouwbare score.Doel Het doel van dit project is het onderzoeken van de feasibility (haalbaarheid) van voor de fysiotherapie relevante PROMIS-CAT instrumenten. Resultaten Dit onderzoek loopt nog. We zullen de resultaten hier later publiceren. Het onderzoek is verdeeld in vijf werkpakketten: Wat is de meetfout en bij welke verschilscore is de verandering groter dan de meetfout van de PROMIS-CAT instrumenten (test-hertest betrouwbaarheid en Smallest Detectable Change)? Kunnen de PROMIS-CAT instrumenten verandering goed meten en met welke score is de verandering relevant voor patiënten (responsiviteit en Minimal Important Change)? Wat is de behoefte, aanvaardbaarheid, implementeerbaarheid en praktische toepasbaarheid van de PROMIS-CAT instrumenten? Welke scholing kunnen we ontwikkelen die nodig is voor implementatie van de PROMIS-CAT instrumenten in de eerstelijns fysiotherapie? Wat is het effect van deze scholing op het gebruik en de haalbaarheid van de PROMIS-CAT instrumenten? Looptijd 01 juni 2021 - 31 mei 2023 Aanpak In een pilotproject zijn de PROMIS-CAT instrumenten ingebouwd in het Elektronisch Patiënten Dossier “Fysiomanager”. Fysiotherapeuten nemen de PROMIS-CAT instrumenten gedurende een half jaar af, naast de huidige gebruikte vragenlijsten. Door middel van interviews worden ervaringen van fysiotherapeuten en patiënten in kaart gebracht en wordt een scholing ontwikkeld en geëvalueerd. Relevantie Indien de PROMIS-CAT instrumenten goede meeteigenschappen hebben en praktisch goed toepasbaar zijn, kan de belasting voor het invullen van vragenlijsten voor patiënten en fysiotherapeuten aanzienlijk afnemen. De verwachting is dat de PROMIS-CAT instrumenten de huidige lange vragenlijsten op termijn kunnen gaan vervangen en de nieuwe gouden standaard in uitkomstmetingen kunnen worden. Quote Met dit onderzoek brengen we uitkomstgerichte zorg een stukje dichter bij de patiënt en de fysiotherapeut” (Dr. Caroline Terwee, Dutch-Flemish PROMIS National Center).
Vragenlijsten die fysiotherapeuten gebruiken om behandeluitkomsten te meten zijn vaak lang en bevatten soms irrelevante vragen. Dit probleem kan opgelost worden door gebruik te maken van PROMIS-CAT (Computer Adaptief Testen). Door deze slimme manier van meten hoeven nog maar vier tot zeven vragen ingevuld te worden voor een betrouwbare score.
