The George Institute for Global Health, Missenden Road, NSW 2050, Australia.
J Clin Epidemiol. 2012 Mar;65(3):253-61. doi: 10.1016/j.jclinepi.2011.06.018. Epub 2011 Oct 19.
To critically and systematically review methods used to estimate the smallest worthwhile effect of interventions for nonspecific low back pain.
A computerized search was conducted of MEDLINE, CINAHL, LILACS, and EMBASE up to May 2011. Studies were included if they were primary reports intended to measure the smallest worthwhile effect of a health intervention (although they did not need to use this terminology) for nonspecific low back pain.
The search located 31 studies, which provided a total of 129 estimates of the smallest worthwhile effect. The estimates were given a variety of names, including the Minimum Clinically Important Difference, Minimum Important Difference, Minimum Worthwhile Reductions, and Minimum Important Change. Most estimates were obtained using anchor- or distribution-based methods. These methods are not (or not directly) based on patients' perceptions, are not intervention-specific, and are not formulated in terms of differences in outcomes with and without intervention.
The methods used to estimate the smallest worthwhile effect of interventions for low back pain have important limitations. We recommend that the benefit-harm trade-off method be used to estimate the smallest worthwhile effects of intervention because it overcomes these limitations.
批判性和系统地评价评估非特异性下腰痛干预措施最小有意义效应的方法。
对 MEDLINE、CINAHL、LILACS 和 EMBASE 进行计算机检索，检索截至 2011 年 5 月。纳入的研究为旨在测量非特异性下腰痛的健康干预措施最小有意义效应的主要报告（尽管它们不一定使用这一术语）。
检索到 31 项研究，共提供了 129 项最小有意义效应的估计值。这些估计值有多种名称，包括最小临床重要差异、最小重要差异、最小有意义减少和最小重要变化。大多数估计值是使用基于锚点或分布的方法得出的。这些方法不是（或不是直接）基于患者的感知，不是干预特异性的，也不是用有无干预的结果差异来表示。
用于评估下腰痛干预措施最小有意义效应的方法存在重要局限性。我们建议使用效益-危害权衡方法来估计干预措施的最小有意义效应，因为它克服了这些局限性。
