Asogwa Ogechukwu A, Koekkoek Johan A F, Peeters Marthe C M, Zwinkels Hanneke, Vos Maaike J, Dirven Linda, Taphoorn Martin J B
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.
Qual Life Res. 2025 Aug 5. doi: 10.1007/s11136-025-04029-3.
Interpretation of changes on the individual level is often based on minimally important differences (MIDs) developed on the group level. We investigated the impact of applying different group-level MIDs (anchor-based and 10-point MIDs) to determine health-related quality of life (HRQoL) changes in glioma patients. We further explored directions and magnitudes of these changes and their relationship to response formats and types of scale.
We included 92 glioma patients at least 18 years old from a previously conducted randomized prospective study. We calculated changes in HRQoL (EORTC QLQ-C30 and QLQ-BN20) at individual levels over a two-week period and used anchor-based and 10-point MIDs to estimate if change is clinically meaningful; thereafter, we explored the direction and magnitude of changes.
Between 8.8% and 66.3% of the patients had actual changes in estimated scales. While 16.3%-60.9% and 8.8%-59.8% of the patients changed to a clinically relevant extent using anchor-based and 10-point MIDs in any scale, respectively. Changes were mostly in the functional than symptom scales and mostly minor, i.e., changes between 'not at all' and 'a little' or 'a little' and 'quite a bit.'
10-point compared to anchor-based MIDs underestimates clinically relevant changes. Therefore, the application of different MIDs to the same research question can lead to diverse result interpretations. As most changes were minor, it could be argued if these reflect actual relevant changes for an individual or that the current response scale lacks sufficient differentiating ability, warranting further research over the best method to evaluate individual-level changes.
个体水平变化的解读通常基于群体水平上制定的最小重要差异（MIDs）。我们研究了应用不同的群体水平MIDs（基于锚定的和10分制MIDs）来确定胶质瘤患者健康相关生活质量（HRQoL）变化的影响。我们进一步探讨了这些变化的方向和幅度及其与反应格式和量表类型的关系。
我们纳入了来自之前进行过的随机前瞻性研究的92例至少18岁的胶质瘤患者。我们计算了两周内个体水平上HRQoL（欧洲癌症研究与治疗组织核心量表QLQ-C30和脑肿瘤附加量表QLQ-BN20）的变化，并使用基于锚定的和10分制MIDs来估计变化是否具有临床意义；此后，我们探讨了变化的方向和幅度。
在估计量表中，8.8%至66.3%的患者有实际变化。在任何量表中，分别有16.3% - 60.9%和8.8% - 59.8%的患者使用基于锚定的和10分制MIDs发生了具有临床相关性的变化。变化大多发生在功能量表而非症状量表上，且大多较小，即介于“完全没有”和“有一点”或“有一点”和“相当多”之间的变化。
与基于锚定的MIDs相比，10分制MIDs低估了具有临床相关性的变化。因此，将不同的MIDs应用于同一个研究问题可能导致不同的结果解读。由于大多数变化较小，有人可能会质疑这些变化是否反映了个体的实际相关变化，或者当前的反应量表是否缺乏足够的区分能力，这需要对评估个体水平变化的最佳方法进行进一步研究。
