The Minimal Clinically Important Difference: A Review of Clinical Significance
- PMID: 34854345
- DOI: 10.1177/03635465211053869
The Minimal Clinically Important Difference: A Review of Clinical Significance
Abstract
Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature.
Purpose: To describe the various modalities for deriving the MCID.
Study design: Narrative review; Level of evidence, 4.
Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations.
Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient's clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question.
Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design-namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation.
Keywords: clinical assessment; education; grading scales; statistics.
Comment in
-
The Minimal Clinically Important Difference: Letter to the Editor.Am J Sports Med. 2023 Nov;51(13):NP51-NP52. doi: 10.1177/03635465231189223. Am J Sports Med. 2023. PMID: 37917817 No abstract available.
Similar articles
-
What Are the Minimum Clinically Important Differences in SF-36 Scores in Patients with Orthopaedic Oncologic Conditions?Clin Orthop Relat Res. 2020 Sep;478(9):2148-2158. doi: 10.1097/CORR.0000000000001341. Clin Orthop Relat Res. 2020. PMID: 32568896 Free PMC article.
-
What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions?Clin Orthop Relat Res. 2018 Oct;476(10):2027-2036. doi: 10.1097/CORR.0000000000000419. Clin Orthop Relat Res. 2018. PMID: 30179950 Free PMC article.
-
Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.Foot Ankle Int. 2017 May;38(5):551-557. doi: 10.1177/1071100716688724. Epub 2017 Feb 13. Foot Ankle Int. 2017. PMID: 28193121
-
Substantial Inconsistency and Variability Exists Among Minimum Clinically Important Differences for Shoulder Arthroplasty Outcomes: A Systematic Review.Clin Orthop Relat Res. 2022 Jul 1;480(7):1371-1383. doi: 10.1097/CORR.0000000000002164. Epub 2022 Mar 17. Clin Orthop Relat Res. 2022. PMID: 35302970 Free PMC article.
-
Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part I: Upper Extremity: A Systematic Review.JBJS Rev. 2018 Sep;6(9):e1. doi: 10.2106/JBJS.RVW.17.00159. JBJS Rev. 2018. PMID: 30179897
Cited by
-
An Evaluation of Patient-reported Outcome Measures and Minimal Clinically Important Difference Usage in Hand Surgery.Plast Reconstr Surg Glob Open. 2023 Dec 18;11(12):e5490. doi: 10.1097/GOX.0000000000005490. eCollection 2023 Dec. Plast Reconstr Surg Glob Open. 2023. PMID: 38111720 Free PMC article.
-
Mapping the reporting practices in recent randomised controlled trials published in Knee Surgery, Sports Traumatology, Arthroscopy: A scoping review of methodological quality.J Exp Orthop. 2025 Jan 7;12(1):e70117. doi: 10.1002/jeo2.70117. eCollection 2025 Jan. J Exp Orthop. 2025. PMID: 39776837 Free PMC article.
-
Establishing metrics of clinically meaningful change for treating knee osteoarthritis with a combination of autologous orthobiologics.Sci Rep. 2025 Feb 28;15(1):7244. doi: 10.1038/s41598-025-91972-3. Sci Rep. 2025. PMID: 40021765 Free PMC article.
-
Digital Physiotherapeutic Scoliosis-Specific Exercises for Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial.JAMA Netw Open. 2025 Feb 3;8(2):e2459929. doi: 10.1001/jamanetworkopen.2024.59929. JAMA Netw Open. 2025. PMID: 39964686 Free PMC article. Clinical Trial.
-
The minimal clinically important difference changes greatly based on the patient's baseline clinical status.J Exp Orthop. 2025 Feb 10;12(1):e70137. doi: 10.1002/jeo2.70137. eCollection 2025 Jan. J Exp Orthop. 2025. PMID: 39931152 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Research Materials
Miscellaneous