The Minimal Important Change for the EQ VAS Based on the SF-36 Health Transition Item: Observations from 25772 Spine Surgery Procedures

Overview

Journal Qual Life Res

Specialties Pharmacology
Rehabilitation Medicine

Date 2022 Jul 12

PMID 35821173

Authors

Anders Joelson

Fredrik Nerelius

Freyr Gauti Sigmundsson

Jan Karlsson

Affiliations

Soon will be listed here.

Abstract

Purpose: The EQ VAS is an integral part of EQ-5D, a commonly used instrument for health-related quality of life assessment. This study aimed to calculate the minimal important change (MIC) thresholds for the EQ VAS for improvement and deterioration after surgery for disk herniation or spinal stenosis.

Methods: Patients, who were surgically treated for disk herniation or spinal stenosis between 2007 and 2016, were recruited from the Swedish spine register. Preoperative and 1-year postoperative data for a total of 25772 procedures were available for analysis. We used two anchor-based methods to estimate MIC for EQ VAS: (1) a predictive model based on logistic regression and (2) receiver operating characteristics (ROC) curves. The SF-36 health transition item was used as anchor.

Results: The EQ VAS MIC threshold for improvement after disk herniation surgery ranged from 8.25 to 11.8 while the corresponding value for deterioration ranged from - 6.17 to 0.5. For spinal stenosis surgery the corresponding MIC values ranged from 10.5 to 14.5 and - 7.16 to - 6.5 respectively. There were moderate negative correlations (disk herniation - 0.47, spinal stenosis - 0.46) between the 1 year change in the EQ VAS and the SF-36 health transition item (MIC anchor).

Conclusions: For EQ VAS, we recommend a MIC threshold of 12 points for improvement after surgery for disk herniation or spinal stenosis, whereas the corresponding threshold for deterioration is - 7 points. There are marked differences between the EQ VAS MIC for improvement and deterioration after surgery for disk herniation or spinal stenosis. The MIC value varied depending on the method used for MIC estimation.

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References

Revicki D, Hays R, Cella D, Sloan J . Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008; 61(2):102-9. DOI: 10.1016/j.jclinepi.2007.03.012. View

Chung A, Copay A, Olmscheid N, Campbell D, Walker J, Chutkan N . Minimum Clinically Important Difference: Current Trends in the Spine Literature. Spine (Phila Pa 1976). 2016; 42(14):1096-1105. DOI: 10.1097/BRS.0000000000001990. View

Altman D, Bland J . Diagnostic tests 3: receiver operating characteristic plots. BMJ. 1994; 309(6948):188. PMC: 2540706. DOI: 10.1136/bmj.309.6948.188. View

Sullivan M, Karlsson J, Ware Jr J . The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995; 41(10):1349-58. DOI: 10.1016/0277-9536(95)00125-q. View

Jaeschke R, Singer J, Guyatt G . Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989; 10(4):407-15. DOI: 10.1016/0197-2456(89)90005-6. View

Iderberg H, Willers C, Borgstrom F, Hedlund R, Hagg O, Moller H . Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation. Eur Spine J. 2018; 28(6):1423-1432. DOI: 10.1007/s00586-018-5842-3. View

Beckerman H, Roebroeck M, Lankhorst G, Becher J, Bezemer P, Verbeek A . Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res. 2002; 10(7):571-8. DOI: 10.1023/a:1013138911638. View

Maltenfort M, Diaz-Ledezma C . Statistics In Brief: Minimum Clinically Important Difference-Availability of Reliable Estimates. Clin Orthop Relat Res. 2017; 475(4):933-946. PMC: 5339150. DOI: 10.1007/s11999-016-5204-6. View

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

10.

Terwee C, Terluin B, Knol D, de Vet H . Combining clinical relevance and statistical significance for evaluating quality of life changes in the individual patient. J Clin Epidemiol. 2011; 64(12):1465-7. DOI: 10.1016/j.jclinepi.2011.06.015. View

11.

Terwee C, Peipert J, Chapman R, Lai J, Terluin B, Cella D . Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures. Qual Life Res. 2021; 30(10):2729-2754. PMC: 8481206. DOI: 10.1007/s11136-021-02925-y. View

12.

Beard D, Harris K, Dawson J, Doll H, Murray D, Carr A . Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2014; 68(1):73-9. PMC: 4270450. DOI: 10.1016/j.jclinepi.2014.08.009. View

13.

Solberg T, Johnsen L, Nygaard O, Grotle M . Can we define success criteria for lumbar disc surgery? : estimates for a substantial amount of improvement in core outcome measures. Acta Orthop. 2013; 84(2):196-201. PMC: 3639342. DOI: 10.3109/17453674.2013.786634. View

14.

Bland J, Altman D . Statistics Notes: Bootstrap resampling methods. BMJ. 2015; 350:h2622. DOI: 10.1136/bmj.h2622. View

15.

Guyatt G, Norman G, Juniper E, Griffith L . A critical look at transition ratings. J Clin Epidemiol. 2002; 55(9):900-8. DOI: 10.1016/s0895-4356(02)00435-3. View

16.

Youden W . Index for rating diagnostic tests. Cancer. 1950; 3(1):32-5. DOI: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3. View

17.

Perkins N, Schisterman E . The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006; 163(7):670-5. PMC: 1444894. DOI: 10.1093/aje/kwj063. View

18.

Mouelhi Y, Jouve E, Castelli C, Gentile S . How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020; 18(1):136. PMC: 7218583. DOI: 10.1186/s12955-020-01344-w. View

19.

Thygesen L, Ersboll A . When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol. 2014; 29(8):551-8. DOI: 10.1007/s10654-013-9873-0. View

20.

Joelson A, Stromqvist F, Sigmundsson F, Karlsson J . Single item self-rated general health: SF-36 based observations from 16,910 spine surgery procedures. Qual Life Res. 2021; 31(6):1819-1828. DOI: 10.1007/s11136-021-03048-0. View