From the Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, United Kingdom (TJW, ELW, SX, DWG, ACS); Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom (DWG); and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester Trust, United Kingdom (ACS).
Am J Phys Med Rehabil. 2019 Jun;98(6):431-437. doi: 10.1097/PHM.0000000000001080.
Chronic kidney disease patients are characterized by impaired physical function. The goal of exercise-based interventions is an improvement in functional performance. However, improvements are often determined by "statistically significant" changes. We investigated the "minimum clinically important difference," "the smallest change that is important to the patient," for commonly reported physical function tests.
Nondialysis chronic kidney disease patients completed 12-wks of a combined aerobic (plus resistance training). The incremental shuttle walking test, sit-to-stand 5 and 60, estimated 1-repetition maximum for the knee extensors, and VO2peak were assessed. After the intervention, patients rated their perceived change in health. Both anchor- and distribution-based minimum clinically important difference approaches were calculated.
The minimum clinically important difference was calculated as follows: incremental shuttle walking test, +45 m; sit-to-stand 5, -4.2 secs; VO2peak, +1.5 ml/kg per min. Because of comparable increases in "anchor" groups, no minimum clinically important difference was estimated for the sit-to-stand 60 or estimated 1-repetition maximum.
We have established the minimum clinically important difference in chronic kidney disease for common tests of physical function. These values represent the minimum change required for patients to perceive noticeable and beneficial change to their health. These scores will help interpret changes after exercise interventions where these tests are used. These minimum clinically important differences can be used to power future studies to detect clinically important changes.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Define the "minimum clinically important difference"; (2) Distinguish between concepts of minimum clinically important difference, "minimal detectable change,", and "statistically significant change"; and (3) Interpret other study findings and their own results in the context of the minimum clinically important difference rather than statistically significant changes.
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
慢性肾脏病患者的身体机能受损。运动干预的目标是改善功能表现。然而，改善通常通过“统计学上显著”的变化来确定。我们研究了“最小临床重要差异”，即对患者最重要的“最小变化”，用于常见的身体功能测试。
非透析慢性肾脏病患者完成了 12 周的有氧运动（加抗阻训练）。递增式穿梭步行测试、5 次和 60 次坐站测试、估计的 1 次重复最大伸膝力和 VO2peak 均进行了评估。干预后，患者对自己健康状况的变化进行了评分。分别采用基于锚定和基于分布的最小临床重要差异方法进行计算。
最小临床重要差异计算如下：递增式穿梭步行测试，+45m；5 次坐站测试，-4.2 秒；VO2peak，+1.5ml/kg/min。由于“锚定”组的增加相当，因此，60 次坐站测试或估计的 1 次重复最大伸膝力没有估计出最小临床重要差异。
我们已经确定了慢性肾脏病常见身体功能测试的最小临床重要差异。这些值代表了患者感知到对健康有明显和有益的变化所需的最小变化。这些分数将有助于解释使用这些测试后的运动干预后的变化。这些最小临床重要差异可用于为未来的研究提供动力，以检测有临床意义的变化。
要求 CME 学分：完成自我评估活动并在线评估，网址为：http://www.physiatry.org/JournalCME CME 目标：完成本文后，读者应能够：（1）定义“最小临床重要差异”；（2）区分最小临床重要差异、“最小可检测变化”和“统计学上显著变化”的概念；（3）根据最小临床重要差异而不是统计学上显著变化来解释其他研究结果及其自身结果。
高级
学术物理治疗协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理治疗协会将此基于期刊的 CME 活动指定为最多 1.0 个 AMA PRA 类别 1 学分。医生只能要求与其参与活动的程度相称的学分。
