Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life

Journal Name: 
Med Care
OBJECTIVE: To compare the standard error of measurement (SEM) with established standards for clinically relevant intra-individual change in an evaluation of health-related quality of life. DESIGN: Secondary analysis of data from a randomized controlled trial. SUBJECTS: Six hundred and five outpatients with a history of cardiac problems attending the general medicine clinics of a major academic medical center. MEASURES: Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the SF-36. The SEM values corresponding to established standards for minimal clinically important differences (MCIDs) on the CHQ were determined. Individual change on the SF-36 was explored using the same SEM criterion. RESULTS: One-SEM changes in this population corresponded well to the patient-driven MCID standards on all CHQ dimensions (weighted kappas (0.87; P < 0.001). The distributions of outpatients who improved, remained stable, or declined (defined by the one-SEM criterion) were generally consistent between CHQ dimensions and SF-36 subscales. CONCLUSIONS: The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established standards for clinically relevant differences. Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinically meaningful change.
2230, Adult, Aged, Aged,80 and over, analysis, Analysis of Variance, Bias (Epidemiology), Chronic Disease, clinical, Comparative Study, Coronary Disease: epidemiology, differences, evaluation, Female, Health Status Indicators, Heart Failure,Congestive: epidemiology, history, Human, Interviews, Interviews: methods, Life, Lung Diseases,Obstructive: epidemiology, Male, medical, Medicine, Middle Age, Outpatients, patient, population, quality, Quality of Life, Questionnaires, ResNet, Standards, Support,U.S.Gov't,P.H.S.