Copay Anne G, Subach Brian R, Glassman Steven D, Polly David W, Schuler Thomas C
The Spinal Research Foundation, 1831 Wiehle Avenue, Suite 200, Reston, VA 20190, USA.
Spine J. 2007 Sep-Oct;7(5):541-6. doi: 10.1016/j.spinee.2007.01.008. Epub 2007 Apr 2.
The effectiveness of spinal surgery as a treatment option is currently evaluated through the assessment of patient-reported outcomes (PROs). The minimum clinically important difference (MCID) represents the smallest improvement considered worthwhile by a patient. The concept of an MCID is offered as the new standard for determining effectiveness of a given treatment and describing patient satisfaction in reference to that treatment.
Our goal is to review the various definitions of MCID and the methods available to determine MCID.
The primary means of determining the MCID for a specific treatment are divided into anchor-based and distribution-based methods. Each method is further subdivided and examined in detail.
The overall limitations of the MCID concept are first identified. The basic assumptions, statistical biases, and shortcomings of each method are examined in detail.
Each method of determining the MCID has specific shortcomings. Three general limitations in the accurate determination of an MCID have been identified: the multiplicity of MCID determinations, the loss of the patient's perspective, and the relationship between pretreatment baseline and posttreatment change scores.
An ideal means of determining the MCID for a given intervention is yet to be determined. It is possible to develop a useful method provided that the assumptions and methodology are initially declared. Our efforts toward the establishment of a MCID will rely on the establishment of specific external criteria based on the symptoms of the patient and treatment intervention being evaluated.
目前通过评估患者报告结局（PROs）来评价脊柱手术作为一种治疗选择的有效性。最小临床重要差异（MCID）代表患者认为值得的最小改善。MCID的概念被作为确定特定治疗有效性以及描述患者对该治疗满意度的新标准提出。
我们的目标是回顾MCID的各种定义以及用于确定MCID的可用方法。
确定特定治疗MCID的主要方法分为基于锚定的方法和基于分布的方法。对每种方法进一步细分并详细研究。
首先确定MCID概念的总体局限性。详细研究每种方法的基本假设、统计偏差和缺点。
确定MCID的每种方法都有特定缺点。已确定准确确定MCID存在三个一般局限性：MCID确定的多样性、患者观点的缺失以及治疗前基线与治疗后变化分数之间的关系。
尚未确定确定给定干预措施MCID的理想方法。只要最初声明假设和方法，就有可能开发出一种有用的方法。我们建立MCID的努力将依赖于根据所评估患者的症状和治疗干预建立特定的外部标准。
