A step-by-step approach for selecting an optimal minimal important difference

When measuring a health state experienced and best known by patients, physiological measures and clinicians’ estimates have serious limitations. Thus, the direct measurement of patients’ perspectives represents the only satisfactory approach. Clinicians and researchers can measure patient experience—including symptom status, physical function, mental health, social function, wellbeing, and quality of life—using patient reported outcome measures (PROMs). Use of PROMs enhances understanding of the effects of interventions designed to affect disease status and course on patients’ lives.123 Authorities thus advocate for using PROMs as endpoint measures in clinical trials examining treatment effects.45678PROM results are, however, challenging to interpret. Provided with large enough sample size, small differences in PROM scores within or between groups that might not be important to patients could achieve statistical significance.9 Researchers have proposed that the minimal important difference (MID), the smallest change or difference that patients perceive as important (on average), could aid interpretation of PROM scores.1011…
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