OBJECTIVE: To critically and systematically review methods used to estimate the smallest worthwhile effect of interventions for nonspecific low back pain. STUDY DESIGN AND SETTING: A computerized search was conducted of MEDLINE, CINAHL, LILACS, and EMBASE up to May 2011. Studies were included if they were primary reports intended to measure the smallest worthwhile effect of a health intervention (although they did not need to use this terminology) for nonspecific low back pain. RESULTS: The search located 31 studies, which provided a total of 129 estimates of the smallest worthwhile effect. The estimates were given a variety of names, including the Minimum Clinically Important Difference, Minimum Important Difference, Minimum Worthwhile Reductions, and Minimum Important Change. Most estimates were obtained using anchor- or distribution-based methods. These methods are not (or not directly) based on patients' perceptions, are not intervention-specific, and are not formulated in terms of differences in outcomes with and without intervention. CONCLUSION: The methods used to estimate the smallest worthwhile effect of interventions for low back pain have important limitations. We recommend that the benefit-harm trade-off method be used to estimate the smallest worthwhile effects of intervention because it overcomes these limitations.
AD - The George Institute for Global Health, Missenden Road, NSW 2050, Australia. mferreira@george.org.au AN - 22014888 BT - Journal of Clinical Epidemiology ET - 2011/10/22 LA - eng M1 - 3 N1 - Ferreira, Manuela LHerbert, Robert DFerreira, Paulo HLatimer, JaneOstelo, Raymond WNascimento, Dafne PSmeets, Rob JReviewUnited StatesJournal of clinical epidemiologyJ Clin Epidemiol. 2012 Mar;65(3):253-61. Epub 2011 Oct 19. N2 -OBJECTIVE: To critically and systematically review methods used to estimate the smallest worthwhile effect of interventions for nonspecific low back pain. STUDY DESIGN AND SETTING: A computerized search was conducted of MEDLINE, CINAHL, LILACS, and EMBASE up to May 2011. Studies were included if they were primary reports intended to measure the smallest worthwhile effect of a health intervention (although they did not need to use this terminology) for nonspecific low back pain. RESULTS: The search located 31 studies, which provided a total of 129 estimates of the smallest worthwhile effect. The estimates were given a variety of names, including the Minimum Clinically Important Difference, Minimum Important Difference, Minimum Worthwhile Reductions, and Minimum Important Change. Most estimates were obtained using anchor- or distribution-based methods. These methods are not (or not directly) based on patients' perceptions, are not intervention-specific, and are not formulated in terms of differences in outcomes with and without intervention. CONCLUSION: The methods used to estimate the smallest worthwhile effect of interventions for low back pain have important limitations. We recommend that the benefit-harm trade-off method be used to estimate the smallest worthwhile effects of intervention because it overcomes these limitations.
PY - 2012 SN - 1878-5921 (Electronic)0895-4356 (Linking) SP - 253 EP - 61 ST - T2 - Journal of Clinical Epidemiology TI - A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain VL - 65 ER -