OBJECTIVE: To compare the standard error of measurement (SEM) with established standards for clinically relevant intra-individual change in an evaluation of health-related quality of life. DESIGN: Secondary analysis of data from a randomized controlled trial. SUBJECTS:Six hundred and five outpatients with a history of cardiac problems attending the general medicine clinics of a major academic medical center. MEASURES: Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the SF-36. The SEM values corresponding to established standards for minimal clinically important differences (MCIDs) on the CHQ were determined. Individual change on the SF-36 was explored using the same SEM criterion. RESULTS: One-SEM changes in this population corresponded well to the patient-driven MCID standards on all CHQ dimensions (weighted kappas (0.87; P < 0.001). The distributions of outpatients who improved, remained stable, or declined (defined by the one-SEM criterion) were generally consistent between CHQ dimensions and SF-36 subscales. CONCLUSIONS: The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established standards for clinically relevant differences. Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinically meaningful change.
RCT Entities:
OBJECTIVE: To compare the standard error of measurement (SEM) with established standards for clinically relevant intra-individual change in an evaluation of health-related quality of life. DESIGN: Secondary analysis of data from a randomized controlled trial. SUBJECTS: Six hundred and five outpatients with a history of cardiac problems attending the general medicine clinics of a major academic medical center. MEASURES: Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the SF-36. The SEM values corresponding to established standards for minimal clinically important differences (MCIDs) on the CHQ were determined. Individual change on the SF-36 was explored using the same SEM criterion. RESULTS: One-SEM changes in this population corresponded well to the patient-driven MCID standards on all CHQ dimensions (weighted kappas (0.87; P < 0.001). The distributions of outpatients who improved, remained stable, or declined (defined by the one-SEM criterion) were generally consistent between CHQ dimensions and SF-36 subscales. CONCLUSIONS: The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established standards for clinically relevant differences. Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinically meaningful change.
Authors: Michael Seid; Elizabeth J D'Amico; James W Varni; Jennifer K Munafo; Maria T Britto; Carolyn M Kercsmar; Dennis Drotar; Eileen C King; Lynn Darbie Journal: J Pediatr Psychol Date: 2011-12-13
Authors: Hermine I Brunner; Gloria C Higgins; Marisa S Klein-Gitelman; Sivia K Lapidus; Judyann C Olson; Karen Onel; Marilynn Punaro; Jun Ying; Edward H Giannini Journal: Arthritis Care Res (Hoboken) Date: 2010-07 Impact factor: 4.794
Authors: Kathleen W Wyrwich; Stephan D Fihn; William M Tierney; Kurt Kroenke; Ajit N Babu; Fredric D Wolinsky Journal: J Gen Intern Med Date: 2003-03 Impact factor: 5.128