Robert M Kaplan1. 1. Department of Health Services, UCLA School of Public Health, PO Box 951772, Room 31-293C CHS, Los Angeles, California 90095-1772, USA. rmkaplan@ucla.edu
Abstract
PURPOSE: To evaluate the use of utility-based generic quality of life measures for establishing the minimally clinically important difference (MCID). BACKGROUND: Utility-based quality of life measures place levels of wellness on a continuum anchored by death (0.00) and optimum function (1.00). Preference measurement studies are used to define the meaning of points along the continuum. Health states that differ by less than 0.03 units cannot be discriminated by panels of judges as different from one another. Thus, 0.03 is a reasonable MCID for these measures. METHOD: Three published studies of patients with Chronic Obstructive Pulmonary Disease (COPD) reported data on the Quality of Well-being Scale (QWB) before and after pulmonary rehabilitation. One of the studies also randomly assigned patients to lung volume reduction surgery or to maximal medical therapy. These patients were followed for an average of 29 months. RESULTS: All three evaluations of pulmonary rehabilitation showed changes on the QWB in excess of the proposed 0.03 MCID. QWB changes for patients assigned to lung volume reduction surgery were close to the MCID threshold at one year but grew stronger in subsequent years. Using Norman's 0.50 standard deviation method, all three estimates of rehabilitation effectiveness and the outcomes one year following surgery fall below the MCID. CONCLUSION: Different methods for estimating MCID lead to different conclusions about the meaning of quality of life changes following pulmonary rehabilitation and lung volume reduction surgery. The preference scaling system in generic utility-based quality of life measures provides a metric that is directly interpretable and avoids many of the criticisms of MCID measures. The method is sensitive enough to suggest clinically meaningful benefits of rehabilitation and surgery. Further, quality adjusted life years offer a valuable metric for policy analysis. Utility-based measures of health related quality of life should gain greater use in COPD outcomes research.
RCT Entities:
PURPOSE: To evaluate the use of utility-based generic quality of life measures for establishing the minimally clinically important difference (MCID). BACKGROUND: Utility-based quality of life measures place levels of wellness on a continuum anchored by death (0.00) and optimum function (1.00). Preference measurement studies are used to define the meaning of points along the continuum. Health states that differ by less than 0.03 units cannot be discriminated by panels of judges as different from one another. Thus, 0.03 is a reasonable MCID for these measures. METHOD: Three published studies of patients with Chronic Obstructive Pulmonary Disease (COPD) reported data on the Quality of Well-being Scale (QWB) before and after pulmonary rehabilitation. One of the studies also randomly assigned patients to lung volume reduction surgery or to maximal medical therapy. These patients were followed for an average of 29 months. RESULTS: All three evaluations of pulmonary rehabilitation showed changes on the QWB in excess of the proposed 0.03 MCID. QWB changes for patients assigned to lung volume reduction surgery were close to the MCID threshold at one year but grew stronger in subsequent years. Using Norman's 0.50 standard deviation method, all three estimates of rehabilitation effectiveness and the outcomes one year following surgery fall below the MCID. CONCLUSION: Different methods for estimating MCID lead to different conclusions about the meaning of quality of life changes following pulmonary rehabilitation and lung volume reduction surgery. The preference scaling system in generic utility-based quality of life measures provides a metric that is directly interpretable and avoids many of the criticisms of MCID measures. The method is sensitive enough to suggest clinically meaningful benefits of rehabilitation and surgery. Further, quality adjusted life years offer a valuable metric for policy analysis. Utility-based measures of health related quality of life should gain greater use in COPD outcomes research.
Authors: Angela Marinilli Pinto; Leslee L Subak; Sanae Nakagawa; Eric Vittinghoff; Rena R Wing; John W Kusek; William H Herman; Delia Smith West; Miriam Kuppermann Journal: Qual Life Res Date: 2011-12-10 Impact factor: 4.147
Authors: Gary Naglie; David B Hogan; Murray Krahn; B Lynn Beattie; Sandra E Black; Chris Macknight; Morris Freedman; Christopher Patterson; Michael Borrie; Howard Bergman; Anna Byszewski; David Streiner; Jane Irvine; Paul Ritvo; Janna Comrie; Matthew Kowgier; George Tomlinson Journal: Am J Geriatr Psychiatry Date: 2011-10 Impact factor: 4.105
Authors: Gary Naglie; David B Hogan; Murray Krahn; Sandra E Black; B Lynn Beattie; Christopher Patterson; Chris Macknight; Morris Freedman; Michael Borrie; Anna Byszewski; Howard Bergman; David Streiner; Jane Irvine; Paul Ritvo; Janna Comrie; Matthew Kowgier; George Tomlinson Journal: Am J Geriatr Psychiatry Date: 2011-10 Impact factor: 4.105
Authors: David Feeny; Karen Spritzer; Ron D Hays; Honghu Liu; Theodore G Ganiats; Robert M Kaplan; Mari Palta; Dennis G Fryback Journal: Med Decis Making Date: 2011-10-18 Impact factor: 2.583
Authors: Erik J Groessl; Robert M Kaplan; W Jack Rejeski; Jeffrey A Katula; Abby C King; Georita Frierson; Nancy W Glynn; Fang-Chi Hsu; Michael Walkup; Marco Pahor Journal: Am J Prev Med Date: 2007-09 Impact factor: 5.043
Authors: Lucas M Donovan; Laura C Feemster; Edmunds M Udris; Matthew F Griffith; Laura J Spece; Brian N Palen; Ken He; Sairam Parthasarathy; Kingman P Strohl; Vishesh K Kapur; David H Au Journal: J Clin Sleep Med Date: 2019-01-15 Impact factor: 4.062
Authors: Erik J Groessl; Robert M Kaplan; W Jack Rejeski; Jeffrey A Katula; Nancy W Glynn; Abby C King; Stephen D Anton; Michael Walkup; Ching-Ju Lu; Kieran Reid; Bonnie Spring; Marco Pahor Journal: Am J Prev Med Date: 2019-01 Impact factor: 5.043
Authors: Fatima Al Sayah; Calypse Agborsangaya; Markus Lahtinen; Tim Cooke; Jeffrey A Johnson Journal: Can Fam Physician Date: 2014-02 Impact factor: 3.275
Authors: Noelle C Garster; Mari Palta; Nancy K Sweitzer; Robert M Kaplan; Dennis G Fryback Journal: Qual Life Res Date: 2009-09-16 Impact factor: 4.147