School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
BMC Musculoskelet Disord. 2023 Mar 2;24(1):158. doi: 10.1186/s12891-023-06261-9.
Minimal important difference (MID) is a concept used inconsistently and arbitrarily in tendinopathy research. Our aim was to determine the MIDs for the most commonly used tendinopathy outcome measures using data-driven approaches.
Recently published systematic reviews of randomised controlled trials (RCTs) on tendinopathy management were identified and used for extraction of eligible studies through a literature search. Each eligible RCT was used to obtain information on MID where this was used and it also contributed data for the calculation of the baseline pooled standard deviation (SD) for each tendinopathy (shoulder, lateral elbow, patellar and Achilles). The rule of "half SD" was used for the computation of MIDs for patient-reported pain (visual analogue scale, VAS 0-10, single-item questionnaire) and function (multi-item questionnaires) and the rule of "one standard error of measurement (SEM)" was additionally used for the multi-item functional outcome measures.
A total of 119 RCTs were included for the 4 tendinopathies. MID was defined and used by 58 studies (49%) and there were significant inconsistencies amongst studies where the same outcome measure was used as MID. From our data-driven methods the following suggested MIDs were obtained: a) Shoulder tendinopathy, pain VAS (combined) 1.3 points, Constant-Murley score 6.9 (half SD) and 7.0 (one SEM) points; b) lateral elbow tendinopathy, pain VAS (combined) 1.0 point, Disabilities of Arm, Shoulder and Hand questionnaire 8.9 (half SD) and 4.1 (one SEM) points; c) Patellar tendinopathy, pain VAS (combined) 1.2 points, Victorian Institute of Sport Assessment - Patella (VISA-P) 7.3 (half SD) and 6.6 points (one SEM); d) Achilles tendinopathy, pain VAS (combined) 1.1 points, VISA-Achilles (VISA-A) 8.2 (half SD) and 7.8 points (one SEM). The rules of half SD and one SEM produced very similar MIDs except for DASH due to its very high internal consistency. MIDs were also calculated for different pain settings for each tendinopathy.
Our computed MIDs can be used in tendinopathy research to increase consistency. Clearly defined MIDs should be used with consistency in tendinopathy management studies in the future.
最小有意义差异（MID）在腱病研究中被不一致且任意地使用。我们的目的是使用数据驱动的方法确定最常用腱病结局测量的 MID。
最近发表的关于腱病管理的随机对照试验（RCT）的系统评价被确定，并通过文献检索用于提取合格研究。每个合格的 RCT 都用于获取使用 MID 的信息，并且它还为计算每个腱病（肩部、外侧肘部、髌腱和跟腱）的基线汇总标准偏差（SD）贡献数据。对于患者报告的疼痛（视觉模拟量表，VAS 0-10，单项问卷）和功能（多项问卷）的 MID，使用“半 SD”规则进行计算，对于多项目功能结局测量，使用“一个测量标准误差（SEM）”规则。
共有 119 项 RCT 被纳入 4 种腱病。58 项研究（49%）定义和使用了 MID，并且在使用相同的结局测量作为 MID 时，研究之间存在显著的不一致。从我们的数据驱动方法中，得到了以下建议的 MID：a）肩部腱病，疼痛 VAS（综合）1.3 分，Constant-Murley 评分 6.9（半 SD）和 7.0（一个 SEM）分；b）外侧肘部腱病，疼痛 VAS（综合）1.0 分，上肢功能障碍问卷 8.9（半 SD）和 4.1（一个 SEM）分；c）髌腱病，疼痛 VAS（综合）1.2 分，维多利亚运动评估-髌腱（VISA-P）7.3（半 SD）和 6.6 分（一个 SEM）；d）跟腱病，疼痛 VAS（综合）1.1 分，跟腱 Achilles 功能评估（VISA-A）8.2（半 SD）和 7.8 分（一个 SEM）。半 SD 和一个 SEM 规则产生的 MID 非常相似，除了 DASH，因为它的内部一致性非常高。还为每种腱病的不同疼痛设置计算了 MID。
我们计算的 MID 可用于腱病研究，以提高一致性。在未来的腱病管理研究中，应明确定义并一致使用 MID。
