Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures

Caroline B Terwee, John Devin Peipert, Robert Chapman, Jin-Shei Lai, Berend Terluin, David Cella, Pip Griffiths, Lidwine B Mokkink, Caroline B Terwee, John Devin Peipert, Robert Chapman, Jin-Shei Lai, Berend Terluin, David Cella, Pip Griffiths, Lidwine B Mokkink

Abstract

We define the minimal important change (MIC) as a threshold for a minimal within-person change over time above which patients perceive themselves importantly changed. There is a lot of confusion about the concept of MIC, particularly about the concepts of minimal important change and minimal detectable change, which questions the validity of published MIC values. The aims of this study were: (1) to clarify the concept of MIC and how to use it; (2) to provide practical guidance for estimating methodologically sound MIC values; and (3) to improve the applicability of PROMIS by summarizing the available evidence on plausible PROMIS MIC values. We discuss the concept of MIC and how to use it and provide practical guidance for estimating MIC values. In addition, we performed a systematic review in PubMed on MIC values of any PROMIS measure from studies using recommended approaches. A total of 50 studies estimated the MIC of a PROMIS measure, of which 19 studies used less appropriate methods. MIC values of the remaining 31 studies ranged from 0.1 to 12.7 T-score points. We recommend to use the predictive modeling method, possibly supplemented with the vignette-based method, in future MIC studies. We consider a MIC value of 2-6 T-score points for PROMIS measures reasonable to assume at this point. For surgical interventions a higher MIC value might be appropriate. We recommend more high-quality studies estimating MIC values for PROMIS.

Keywords: Interpretation; Methodology; Minimal important change; PROMIS; Patient-reported outcomes.

Conflict of interest statement

D. Cella was co-author on one of the included PROMIS MIC papers [44] and CB. Terwee was co-authors of another included PROMIS MIC paper [89], but both were not involved in the data extraction of these papers. CB. Terwee and D. Cella are board members of the PROMIS Health Organization. The other authors have no conflicts of interest to declare that are relevant to the content of this article.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
MICmean and MICROC. On the left, the distribution of change scores in all patients who are ‘improved’ (larger distribution) and in patients who are ‘a little better’ (smaller distribution), on the right the distribution of change scores in patients who are ‘not improved’. The upper line represents the MICmean (based on the smaller distribution on the left side), the lower line represents the MICROC (based on the larger left-sided distribution and the right-sided distribution)

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Source: PubMed

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