Malec James F, Kean Jacob, Monahan Patrick O
Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis (Dr Malec); Salt Lake City VA Health Care System, Health System Innovation and Research, Departments of Population Health Sciences and Communication Sciences and Disorders, University of Utah, Salt Lake City (Dr Kean); and Department of Biostatistics and Department of Public Health, Indiana University School of Medicine, Indianapolis (Dr Monahan).
J Head Trauma Rehabil. 2017 Jul/Aug;32(4):E47-E54. doi: 10.1097/HTR.0000000000000268.
To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention.
Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings.
Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings.
MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement.
Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement.
5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.
确定梅奥-波特兰适应性量表-4（MPAI-4）作为干预反应指标的最小临床重要差异（MCID）和稳健临床重要差异（RCID）。
对现有数据进行回顾性分析。采用基于分布和锚定的方法来确定MCID，并识别MPAI-4的适度（即更稳健）变化水平（RCID）。并根据临床医生的评分对这些结果进行进一步评估。
来自美国各地康复项目中脑损伤患者的数据，这些数据存储在OutcomeInfo数据库中（n = 3087），有两次MPAI-4评分。
MPAI-4、监督评定量表、临床医生对整体临床改善的评定。
初步分析表明，5个T分点（5T）为MCID，9个T分点为RCID。81%至87%的临床评估者认为5T的变化具有意义，99%的评估者认为9T的变化具有意义。
5T代表MPAI-4的MCID，9T代表RCID。这两个值均明显低于可靠变化指数（RCI）。虽然RCI表明变化具有较高的统计置信度，但它可能对临床医生和参与者认为有意义的变化不敏感，如MCID所示。
