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超越统计学意义:接受最小临床重要差异以提供更好的患者护理。

Beyond statistical significance: Embracing minimal clinically important difference for better patient care.

作者信息

Jeyaraman Naveen, Jeyaraman Madhan, Ramasubramanian Swaminathan, Balaji Sangeetha, Muthu Sathish

机构信息

Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India.

Department of Research Methods, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India.

出版信息

World J Methodol. 2025 Mar 20;15(1):97814. doi: 10.5662/wjm.v15.i1.97814.

DOI:10.5662/wjm.v15.i1.97814
PMID:40115403
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11525893/
Abstract

The minimal clinically important difference (MCID) represents a pivotal metric in bridging the gap between statistical significance and clinical relevance, addressing the direct impact of medical interventions from the patient's perspective. This comprehensive review analyzes the evolution, applications, and challenges of MCID across medical specialties, emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs. We discuss the evolution of MCID since its inception in the 1980s, its current applications across various medical specialties, and the methodologies used in its calculation, highlighting both anchor-based and distribution-based approaches. Furthermore, the paper delves into the challenges associated with the application of MCID, such as methodological variability and the interpretation difficulties that arise in clinical settings. Recommendations for the future include standardizing MCID calculation methods, enhancing patient involvement in setting MCID thresholds, and extending research to incorporate diverse global perspectives. These steps are critical to refining the role of MCID in patient-centered healthcare, addressing existing gaps in methodology and interpretation, and ensuring that medical interventions lead to significant, patient-perceived improvements.

摘要

最小临床重要差异(MCID)是弥合统计学显著性与临床相关性之间差距的关键指标,从患者角度阐述了医学干预措施的直接影响。这篇综述全面分析了MCID在各医学专科领域的演变、应用及挑战,强调其对于确保临床结果不仅具有统计学显著性,还能提供符合患者期望和需求的真正临床效用的必要性。我们讨论了MCID自20世纪80年代诞生以来的演变过程、目前在各医学专科领域的应用情况以及计算MCID所使用的方法,重点介绍了基于锚定法和基于分布法的方法。此外,本文深入探讨了与MCID应用相关的挑战,例如方法学的变异性以及临床环境中出现的解释困难。对未来的建议包括规范MCID计算方法、加强患者在设定MCID阈值方面的参与度,以及扩展研究以纳入不同的全球视角。这些举措对于完善MCID在以患者为中心的医疗保健中的作用、解决方法学和解释方面的现有差距,以及确保医学干预措施能带来显著的、患者可感知的改善至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/996b/11525893/14324c7ae776/97814-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/996b/11525893/14324c7ae776/97814-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/996b/11525893/14324c7ae776/97814-g001.jpg

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本文引用的文献

1
Bridging the gap between statistical significance and clinical relevance: A systematic review of minimum clinically important difference (MCID) thresholds of scales reported in movement disorders research.弥合统计学显著性与临床相关性之间的差距:运动障碍研究中报告的量表最小临床重要差异(MCID)阈值的系统评价
Heliyon. 2024 Feb 20;10(5):e26479. doi: 10.1016/j.heliyon.2024.e26479. eCollection 2024 Mar 15.
2
Minimal Clinically Important Difference (MCID) in Patient-Reported Outcome Measures for Neurological Conditions: Review of Concept and Methods.神经疾病患者报告结局测量中的最小临床重要差异(MCID):概念与方法综述
Ann Indian Acad Neurol. 2023 Jul-Aug;26(4):334-343. doi: 10.4103/aian.aian_207_23. Epub 2023 Jun 12.
3
What is a minimal clinically important difference for clinical trials in patients with disorders of consciousness? a novel probabilistic approach.
对于意识障碍患者的临床试验,最小有意义临床差异是什么?一种新的概率方法。
PLoS One. 2023 Aug 24;18(8):e0290290. doi: 10.1371/journal.pone.0290290. eCollection 2023.
4
Meaningful benefit and minimal clinically important difference (MCID) in Alzheimer's disease: Open peer commentary.阿尔茨海默病的有意义获益与最小临床重要差异(MCID):公开同行评论
Alzheimers Dement (N Y). 2023 Jul 26;9(3):e12411. doi: 10.1002/trc2.12411. eCollection 2023 Jul-Sep.
5
Minimal Clinically Important Difference: don't just look at the "p-value".最小临床重要差异:不要只看“p值”。
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4077-4079. doi: 10.1007/s00167-023-07512-x. Epub 2023 Jul 17.
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The anchor design of anchor-based method to determine the minimal clinically important difference: a systematic review.基于锚定的方法确定最小临床重要差异的锚点设计:系统评价。
Health Qual Life Outcomes. 2023 Jul 15;21(1):74. doi: 10.1186/s12955-023-02157-3.
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Reporting of PPI and the MCID in phase III/IV randomised controlled trials-a systematic review.报告 PPI 和 MCID 在 III/IV 期随机对照试验中的应用——系统综述。
Trials. 2023 May 31;24(1):370. doi: 10.1186/s13063-023-07367-0.
8
Demystifying the Value of Minimal Clinically Important Difference in the Cardiothoracic Surgery Context.解读心胸外科背景下最小临床重要差异的价值
Life (Basel). 2023 Mar 6;13(3):716. doi: 10.3390/life13030716.
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Am J Sports Med. 2023 Mar;51(4):1067-1073. doi: 10.1177/03635465231152484. Epub 2023 Feb 22.
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Improvement in the Capacity for Activity Versus Improvement in Performance of Activity in Daily Life During Outpatient Rehabilitation.门诊康复期间活动能力的改善与日常生活活动表现的改善。
J Neurol Phys Ther. 2023 Jan 1;47(1):16-25. doi: 10.1097/NPT.0000000000000413. Epub 2022 Aug 4.