Estimating a minimal clinically important difference for the EuroQol 5-dimension health status index in persons with mul
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RESEARCH
Open Access
Estimating a minimal clinically important difference for the EuroQol 5-dimension health status index in persons with multiple sclerosis Christine G Kohn1,2, Matthew F Sidovar3, Kirandeep Kaur1, Yungfen Zhu1 and Craig I Coleman1,2*
Abstract Background: Limited data define what constitutes a minimal clinically important difference (MCID) on the EuroQol 5-Dimension (EQ-5D) health status index in persons with multiple sclerosis (PwMS). We sought to estimate the MCID for the EQ-5D health index in North American PwMS. Methods: PwMS completing the Patient Determined Disease Steps (PDDS) scale, 12-Item Multiple Sclerosis Walking Scale (MSWS-12) and EQ-5D as part of the North American Research Committee on Multiple Sclerosis (NARCOMS) registry’s spring 2011 update and supplemental survey were included in this retrospective, cross-sectional study. Distribution-based (standard error of measurement [SEM], 0.50 standard deviation [SD] and 0.33 SD unit) approaches were used to estimate a range of MCIDs for the EQ-5D based upon disease severity groups determined by the PDDS and MSWS-12 tertiles. Results: A total of 3,044 participants were included. Moderately strong correlations between the EQ-5D and the PDDS and MSWS-12 were observed (Spearman’s r = −0.56 and −0.59, respectively, p < 0.0001 for both). MCID estimates based on PDDS score categories ranged from 0.065-0.158 (SEMs), 0.059-0.142 (0.50 SDs) and 0.039-0.095 (0.33 SDs). MCID estimates as measured by MSWS-12 tertile categories ranged from 0.068-0.098 (SEMs), 0.061-0.088 (0.50 SDs), and 0.041-0.059 (0.33 SDs). Across both the PDDS and tertiles of MSWS-12, MCID estimates tended to be larger as disease severity worsened. Mean weighted MCID estimates ranged from 0.05-0.084 for both the PDDS and MSWS-12 tertiles. Conclusion: MCID estimates for the EQ-5D in PwMS were within the range of estimates seen for other disease states and appeared to be larger in those reporting more severe disease. Keywords: Multiple sclerosis, Quality of life, Health status, EuroQol 5-Dimension, Minimal clinically important difference
Introduction Multiple sclerosis (MS) has long been known to negatively impact health-related quality of life (HRQoL) [1-3]. For this reason, clinical studies have increasingly utilized validated HRQoL measures to evaluate the effect of treatment or the impact of disease progression on HRQoL in persons with MS (PwMS) [4-6]. The Euro-Qol 5-Dimension (EQ-5D), a generic health status index score [7,8], is one such measure; however, interpretation of the EQ-5D in * Correspondence: [email protected] 1 Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA 2 Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA Full list of author information is available at the end of the article
PwMS is hampered by a paucity of information regarding what constitutes a minimally important clinical improvement in score in this population. The purpose of this study was to estimate the minimal clinically imp
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