Gardi Adam, Hum Maxwell, Wong Daniel, Allen Isabel, Sharon Jeffrey D
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF), San Francisco, California, USA.
Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA.
Otolaryngol Head Neck Surg. 2025 Feb;172(2):623-628. doi: 10.1002/ohn.1035. Epub 2024 Oct 30.
To calculate the minimal clinically important difference (MCID) for the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).
Prospective cohort study.
A single tertiary care balance and falls center.
Fifty-three subjects meeting Barany Society criteria for vestibular migraine (VM) or probable VM were included and divided into 3 treatment groups. Treatment was not standardized, instead, management was decided individually between each patient and their provider. All subjects completed VM-PATHI before and after intervention. A Global Rating of Change (GRoC) questionnaire was also completed following intervention. Anchor-based methods, using a GRoC questionnaire, were utilized to estimate the MCID that produced the highest sensitivity and specificity on a receiver operating characteristic (ROC) curve.
Forty-three subjects were classified as responders and 10 were classified as nonresponders. The mean VM-PATHI pretreatment score minus the posttreatment score between the responders (mean = 14, SD 13) and nonresponders (mean = 4 SD = 12) was statistically significant (mean difference = 10, 95% confidence interval, CI [1, 20], P = .03). The VM-PATHI score change cutoff that best differentiated between responders and nonresponders was a VM-PATHI change of 6. Thus, the MCID was defined as a change of 6 points (sensitivity = 72%, specificity = 70%). The area under the ROC curve was 0.89, 95% CI [0.80, 0.98], which demonstrates an excellent ability for the VM-PATHI score change to discriminate between responders and nonresponders. The average change in VM-PATHI scores was 9 points (SD 11) for those with "a little better" rating on the GRoC, 14 points (SD 14) for those with a "moderately better" rating, and 20 points (SD 13) for those with a "very much better" rating.
Patients with VM are likely to demonstrate clinical improvement if their VM-PATHI score decreases by 6 or more.
计算前庭性偏头痛患者评估工具和功能障碍量表（VM-PATHI）的最小临床重要差异（MCID）。
前瞻性队列研究。
一个单一的三级医疗平衡与跌倒中心。
纳入53名符合巴拉尼协会前庭性偏头痛（VM）或可能的VM标准的受试者，并将其分为3个治疗组。治疗未标准化，而是由每位患者与其医疗服务提供者单独决定治疗方案。所有受试者在干预前后均完成VM-PATHI评估。干预后还完成了一份整体变化评分（GRoC）问卷。采用基于锚定的方法，利用GRoC问卷来估计在受试者工作特征（ROC）曲线上产生最高敏感性和特异性的MCID。
43名受试者被归类为反应者，10名被归类为无反应者。反应者（均值=14，标准差13）和无反应者（均值=4，标准差=12）之间的VM-PATHI治疗前评分减去治疗后评分在统计学上具有显著差异（平均差异=10，95%置信区间，CI[1,20]，P=0.03）。最能区分反应者和无反应者的VM-PATHI评分变化临界值为VM-PATHI变化6分。因此，MCID被定义为变化6分（敏感性=72%，特异性=70%）。ROC曲线下面积为0.89，95%CI[0.80,0.98]，这表明VM-PATHI评分变化在区分反应者和无反应者方面具有出色的能力。在GRoC上评为“稍好”的受试者，VM-PATHI评分的平均变化为9分（标准差11）；评为“中度改善”的受试者为14分（标准差14）；评为“非常明显改善”的受试者为20分（标准差13）。
如果VM患者的VM-PATHI评分降低6分或更多，则其临床症状可能会有所改善。
