Advertisement

Quality of Life Research

, Volume 24, Issue 3, pp 607–616 | Cite as

Individual patient monitoring in daily clinical practice: a critical evaluation of minimal important change

  • Jos Hendrikx
  • Jaap Fransen
  • Wietske Kievit
  • Piet L. C. M. van Riel
Article

Abstract

Purpose

In daily practice, physicians translate knowledge from clinical trials to practice, to improve health in individual patients. To help interpret meaningful change on disease outcome measures, the concept of minimal important change (MIC) was conceived. The objective of this study was to investigate whether MIC values are suited for individual patient monitoring.

Methods

Three main elements of the MIC concept were evaluated: (1) MIC values for improvement and deterioration were determined, and the amount of misclassification present in quantifying minimal change was analyzed. (2) Discordance between change categories (improved, unchanged, deteriorated), defined by the MIC values, and patients’ satisfaction with their health was inspected. (3) Discordance between change categories, defined by MIC values, and patients’ willingness to alter therapy was inspected.

Results

MIC value analysis was based on 469 patients with RA seen in daily practice. The chance of falsely classifying health change of an individual patient was high (false-positive range 19–30 % and false-negative range 43–72 %). Of patients classified as improved, 24 % were not satisfied with their health and 69 % were not willing to change therapy. Of patients classified as deteriorated, 54 % were satisfied with their health and 57 % were not willing to change therapy.

Conclusions

The misclassification in the quantification of change and high proportions of discordance between change categories defined by MIC cutoff values and patients’ satisfaction and willingness to alter therapy indicate that MIC values as such are not suited for individual patient monitoring.

Keywords

Personalized care Outcome assessment Psychometrics Clinimetrics Satisfaction Rheumatoid arthritis 

Notes

Acknowledgments

The authors thank the following people for their help in recruiting patients and ensuring excellent data management: Joke Alberts-Pijnenborg, Erik Brummelkamp, Thea van Gaalen, Rienke Korver, Marion de Lange-Brandt, Lia Schalkwijk, Diana van Tuijl, Inge Verhagen-Stolk and Carine Vogel.

Ethical standard

For this study, patients were required to fill out a one page questionnaire before their outpatient clinic visit. Data of these questionnaires were combined with data from a daily practice registry and were only used for research purposes. This type of study is classified as a non-invasive, observational study with a negligible risk and low respondent burden. According to Dutch legal and medical ethical standards, approval of an ethics committee is not required for this type of study and was therefore not obtained. All patients were informed by a specialized rheumatology nurse about the aim and duration of the study and the requirements for participants prior to their inclusion. All participants were free to revoke their participation in the study at any time and without notice of a reason. All data disclosing the identity of subjects were removed before analysis.

References

  1. 1.
    Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10(4), 407–415.CrossRefPubMedGoogle Scholar
  2. 2.
    Ferreira, M. L., Herbert, R. D., Ferreira, P. H., Latimer, J., Ostelo, R. W., Nascimento, D. P., et al. (2012). A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain. Journal of Clinical Epidemiology, 65(3), 253–261.CrossRefPubMedGoogle Scholar
  3. 3.
    Swartz, R. J., Schwartz, C., Basch, E., Cai, L., Fairclough, D. L., McLeod, L., et al. (2011). The king’s foot of patient-reported outcomes: Current practices and new developments for the measurement of change. Quality of Life Research, 20(8), 1159–1167.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Terwee, C. B., Roorda, L. D., Dekker, J., Bierma-Zeinstra, S. M., Peat, G., Jordan, K. P., et al. (2010). Mind the MIC: Large variation among populations and methods. Journal of Clinical Epidemiology, 63(5), 524–534.CrossRefPubMedGoogle Scholar
  5. 5.
    Revicki, D., Hays, R. D., Cella, D., & Sloan, J. (2008). Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of Clinical Epidemiology, 61(2), 102–109.CrossRefPubMedGoogle Scholar
  6. 6.
    Copay, A. G., Subach, B. R., Glassman, S. D., Polly, D. W, Jr, & Schuler, T. C. (2007). Understanding the minimum clinically important difference: A review of concepts and methods. Spine Journal, 7(5), 541–546.CrossRefPubMedGoogle Scholar
  7. 7.
    Tubach, F., Ravaud, P., Beaton, D., Boers, M., Bombardier, C., Felson, D. T., et al. (2007). Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. Journal of Rheumatology, 34(5), 1188–1193.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Crosby, R. D., Kolotkin, R. L., & Williams, G. R. (2003). Defining clinically meaningful change in health-related quality of life. Journal of Clinical Epidemiology, 56(5), 395–407.CrossRefPubMedGoogle Scholar
  9. 9.
    Wells, G., Beaton, D., Shea, B., Boers, M., Simon, L., Strand, V., et al. (2001). Minimal clinically important differences: Review of methods. Journal of Rheumatology, 28(2), 406–412.PubMedGoogle Scholar
  10. 10.
    Curtis, J. R., Shan, Y., Harrold, L., Zhang, J., Greenberg, J. D., & Reed, G. W. (2013). Patient perspectives on achieving treat-to-target goals: A critical examination of patient-reported outcomes. Arthritis Care & Research, 65(10), 1707–1712.Google Scholar
  11. 11.
    Studenic, P., Radner, H., Smolen, J. S., & Aletaha, D. (2012). Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis and Rheumatism, 64(9), 2814–2823.CrossRefPubMedGoogle Scholar
  12. 12.
    Khan, N. A., Spencer, H. J., Abda, E., Aggarwal, A., Alten, R., Ancuta, C., et al. (2012). Determinants of discordance in patients’ and physicians’ rating of rheumatoid arthritis disease activity. Arthritis Care & Research, 64(2), 206–214.CrossRefGoogle Scholar
  13. 13.
    van Hulst, L. T., Kievit, W., van Bommel, R., van Riel, P. L., & Fraenkel, L. (2011). Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: Results of a maximum difference scaling experiment. Arthritis Care & Research, 63(10), 1407–1414.CrossRefGoogle Scholar
  14. 14.
    Sanderson, T., Morris, M., Calnan, M., Richards, P., & Hewlett, S. (2010). What outcomes from pharmacologic treatments are important to people with rheumatoid arthritis? Creating the basis of a patient core set. Arthritis Care Res. (Hoboken), 62(5), 640–646.CrossRefGoogle Scholar
  15. 15.
    Kievit, W., van Hulst, L., van Riel, P., & Fraenkel, L. (2010). Factors that influence rheumatologists’ decisions to escalate care in rheumatoid arthritis: Results from a choice-based conjoint analysis. Arthritis Care & Research, 62(6), 842–847.CrossRefGoogle Scholar
  16. 16.
    Sanderson, T., Morris, M., Calnan, M., Richards, P., & Hewlett, S. (2010). Patient perspective of measuring treatment efficacy: The rheumatoid arthritis patient priorities for pharmacologic interventions outcomes. Arthritis Care & Research, 62(5), 647–656.CrossRefGoogle Scholar
  17. 17.
    Chilton, F., & Collett, R. A. (2008). Treatment choices, preferences and decision-making by patients with rheumatoid arthritis. Musculoskeletal Care, 6(1), 1–14.CrossRefPubMedGoogle Scholar
  18. 18.
    Wolfe, F., & Michaud, K. (2007). Resistance of rheumatoid arthritis patients to changing therapy: Discordance between disease activity and patients’ treatment choices. Arthritis and Rheumatism, 56(7), 2135–2142.CrossRefPubMedGoogle Scholar
  19. 19.
    Leeb, B. F., Sautner, J., Leeb, B. A., Fassl, C., & Rintelen, B. (2006). Lack of agreement between patients’ and physicians’ perspectives of rheumatoid arthritis disease activity changes. Scandinavian Journal of Rheumatology, 35(6), 441–446.CrossRefPubMedGoogle Scholar
  20. 20.
    Leeb, B. F., Andel, I., Leder, S., Leeb, B. A., & Rintelen, B. (2005). The patient’s perspective and rheumatoid arthritis disease activity indexes. Rheumatology (Oxford, England), 44(3), 360–365.CrossRefGoogle Scholar
  21. 21.
    Nicolau, G., Yogui, M. M., Vallochi, T. L., Gianini, R. J., Laurindo, I. M., & Novaes, G. S. (2004). Sources of discrepancy in patient and physician global assessments of rheumatoid arthritis disease activity. Journal of Rheumatology, 31(7), 1293–1296.PubMedGoogle Scholar
  22. 22.
    Beaton, D. E., Boers, M., & Wells, G. A. (2002). Many faces of the minimal clinically important difference (MCID): A literature review and directions for future research. Current Opinion in Rheumatology, 14(2), 109–114.CrossRefPubMedGoogle Scholar
  23. 23.
    Wyrwich, K. W., Norquist, J. M., Lenderking, W. R., Acaster, S., & Industry Advisory Committee of International Society for Quality of Life, R. (2013). Methods for interpreting change over time in patient-reported outcome measures. Quality of Life Research, 22(3), 475–483.CrossRefPubMedGoogle Scholar
  24. 24.
    Wells, G., Anderson, J., Beaton, D., Bellamy, N., Boers, M., Bombardier, C., et al. (2001). Minimal clinically important difference module: Summary, recommendations, and research agenda. Journal of Rheumatology, 28(2), 452–454.PubMedGoogle Scholar
  25. 25.
    DREAM. (2013). Retrieved 2013 May 3, from www.dreamregistry.nl.
  26. 26.
    Smolen, J. S., Landewe, R., Breedveld, F. C., Buch, M., Burmester, G., Dougados, M., et al. (2014). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the Rheumatic Diseases, 73(3), 492–509.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Treadwell, J. R., & Lenert, L. A. (1999). Health values and prospect theory. Medical Decision Making, 19(3), 344–352.CrossRefPubMedGoogle Scholar
  28. 28.
    Cella, D., Hahn, E. A., & Dineen, K. (2002). Meaningful change in cancer-specific quality of life scores: Differences between improvement and worsening. Quality of Life Research, 11(3), 207–221.CrossRefPubMedGoogle Scholar
  29. 29.
    Rouquette, A., Blanchin, M., Sebille, V., Guillemin, F., Cote, S. M., Falissard, B., et al. (2014). The minimal clinically important difference determined using item response theory models: an attempt to solve the issue of the association with baseline score. Journal of Clinical Epidemiology, 67(4), 433–440.CrossRefPubMedGoogle Scholar
  30. 30.
    Pope, J. E., Khanna, D., Norrie, D., & Ouimet, J. M. (2009). The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials. Journal of Rheumatology, 36(2), 254–259.CrossRefPubMedGoogle Scholar
  31. 31.
    Perrot, S., & Bertin, P. (2013). “Feeling better” or “feeling well” in usual care of hip and knee osteoarthritis pain: Determination of cutoff points for patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) at rest and on movement in a national multicenter cohort study of 2414 patients with painful osteoarthritis. Pain, 154(2), 248–256.CrossRefPubMedGoogle Scholar
  32. 32.
    Anderson, J., Caplan, L., Yazdany, J., Robbins, M. L., Neogi, T., Michaud, K., et al. (2012). Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care & Research, 64(5), 640–647.CrossRefGoogle Scholar
  33. 33.
    DAS28.nl. (2013). Retrieved 2013 May 3, from http://www.das28.nl.
  34. 34.
    Anderson, J. K., Zimmerman, L., Caplan, L., & Michaud, K. (2011). Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score with 28-Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Score (PAS) and Patient Activity Score-II (PASII), Routine Assessment of Patient Index Data (RAPID), Rheumatoid Arthritis Disease Activity Index (RADAI) and Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), Chronic Arthritis Systemic Index (CASI), Patient-Based Disease Activity Score With ESR (PDAS1) and Patient-Based Disease Activity Score without ESR (PDAS2), and Mean Overall Index for Rheumatoid Arthritis (MOI-RA). Arthritis Care & Research, 63(Suppl 11), S14–S36.CrossRefGoogle Scholar
  35. 35.
    Association of Rheumatology Health Professionals Outcomes Measures Task, F. (2003). Patient outcomes in rheumatology. A review of measures. Arthritis and Rheumatism, 49(5 Suppl), S1–S232.Google Scholar
  36. 36.
    de Vet, H. C., Terluin, B., Knol, D. L., Roorda, L. D., Mokkink, L. B., Ostelo, R. W., et al. (2010). Three ways to quantify uncertainty in individually applied “minimally important change” values. Journal of Clinical Epidemiology, 63(1), 37–45.CrossRefPubMedGoogle Scholar
  37. 37.
    Aletaha, D., Funovits, J., Ward, M. M., Smolen, J. S., & Kvien, T. K. (2009). Perception of improvement in patients with rheumatoid arthritis varies with disease activity levels at baseline. Arthritis and Rheumatism, 61(3), 313–320.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Ward, M. M., Guthrie, L. C., & Alba, M. (2014). Dependence of the minimal clinically important improvement on the baseline value is a consequence of floor and ceiling effects and not different expectations by patients. Journal of Clinical Epidemiology, 67(6), 689–696.CrossRefPubMedGoogle Scholar
  39. 39.
    Browne, J. P., van der Meulen, J. H., Lewsey, J. D., Lamping, D. L., & Black, N. (2010). Mathematical coupling may account for the association between baseline severity and minimally important difference values. Journal of Clinical Epidemiology, 63(8), 865–874.CrossRefPubMedGoogle Scholar
  40. 40.
    Wang, Y. C., Hart, D. L., Stratford, P. W., & Mioduski, J. E. (2011). Baseline dependency of minimal clinically important improvement. Physical Therapy, 91(5), 675–688.CrossRefPubMedGoogle Scholar
  41. 41.
    Terluin, B. (2012). Mathematical coupling does not account for the association between baseline severity and minimally important change values. Journal of Clinical Epidemiology, 65(4), 355–357.CrossRefPubMedGoogle Scholar
  42. 42.
    Maxwell, J. L., Felson, D. T., Niu, J., Wise, B., Nevitt, M. C., Singh, J. A., et al. (2014). Does clinically important change in function after knee replacement guarantee good absolute function? The multicenter osteoarthritis study. Journal of Rheumatology, 41(1), 60–64.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    van Gestel, A. M., Haagsma, C. J., & van Riel, P. L. (1998). Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis and Rheumatism, 41(10), 1845–1850.CrossRefPubMedGoogle Scholar
  44. 44.
    Ward, M. M., Guthrie, L. C., & Alba, M. I. (2014). Clinically important changes in individual and composite measures of rheumatoid arthritis activity: Thresholds applicable in clinical trials. Annals of the Rheumatic Diseases. doi: 10.1136/annrheumdis-2013-205079.
  45. 45.
    Dougados, M., Brault, Y., Logeart, I., van der Heijde, D., Gossec, L., & Kvien, T. (2012). Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: The example of the Rheumatoid Arthritis Impact of Disease (RAID). Arthritis Research & Therapy, 14(3), R129.CrossRefGoogle Scholar
  46. 46.
    Kvamme, M. K., Kristiansen, I. S., Lie, E., & Kvien, T. K. (2010). Identification of cutpoints for acceptable health status and important improvement in patient-reported outcomes, in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Journal of Rheumatology, 37(1), 26–31.CrossRefPubMedGoogle Scholar
  47. 47.
    Cheung, Y. T., Foo, Y. L., Shwe, M., Tan, Y. P., Fan, G., Yong, W. S., et al. (2014). Minimal clinically important difference (MCID) for the functional assessment of cancer therapy: Cognitive function (FACT-Cog) in breast cancer patients. Journal of Clinical Epidemiology, 67(7), 811–820.Google Scholar
  48. 48.
    de Kleijn, W. P. E., De Vries, J., Wijnen, P., & Drent, M. (2011). Minimal (clinically) important differences for the Fatigue Assessment Scale in sarcoidosis. Respiratory Medicine, 105(9), 1388–1395.CrossRefPubMedGoogle Scholar
  49. 49.
    Heidemann, C. H., Godballe, C., Kjeldsen, A. D., Johansen, E. C. J., Faber, C. E., & Lauridsen, H. H. (2013). The Otitis Media-6 questionnaire: Psychometric properties with emphasis on factor structure and interpretability. Health and Quality of Life Outcomes, 11, 201.CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Holland, A. E., Hill, C. J., Rasekaba, T., Lee, A., Naughton, M. T., & McDonald, C. F. (2010). Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation, 91(2), 221–225.CrossRefPubMedGoogle Scholar
  51. 51.
    Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., et al. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskeletal Disorders, 14, 148.CrossRefPubMedCentralPubMedGoogle Scholar
  52. 52.
    Jorritsma, W., Dijkstra, P. U., de Vries, G. E., Geertzen, J. H. B., & Reneman, M. F. (2012). Detecting relevant changes and responsiveness of Neck Pain and Disability Scale and Neck Disability Index. European Spine Journal, 21(12), 2550–2557.CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Kon, S. S., Dilaver, D., Mittal, M., Nolan, C. M., Clark, A. L., Canavan, J. L., et al. (2013). The Clinical COPD Questionnaire: Response to pulmonary rehabilitation and minimal clinically important difference. Thorax.Google Scholar
  54. 54.
    Murphy, M. A., Willen, C., & Sunnerhagen, K. S. (2013). Responsiveness of upper extremity kinematic measures and clinical improvement during the first three months after stroke. Neurorehabilitation and Neural Repair, 27(9), 844–853.CrossRefGoogle Scholar
  55. 55.
    Packham, J. C., Jordan, K. P., Haywood, K. L., Garratt, A. M., & Healey, E. L. (2012). Evaluation of Ankylosing Spondylitis Quality of Life questionnaire: Responsiveness of a new patient-reported outcome measure. Rheumatology, 51(4), 707–714.CrossRefPubMedGoogle Scholar
  56. 56.
    Smelt, A. F. H., Assendelft, W. J. J., Terwee, C. B., Ferrari, M. D., & Blom, J. W. (2014). What is a clinically relevant change on the HIT-6 questionnaire? An estimation in a primary-care population of migraine patients. Cephalalgia, 34(1), 29–36.CrossRefPubMedGoogle Scholar
  57. 57.
    Grovle, L., Haugen, A. J., Hasvik, E., Natvig, B., Brox, J. I., & Grotle, M. (2014). Patients’ ratings of global perceived change during 2 years were strongly influenced by the current health status. Journal of Clinical Epidemiology, 67(5), 508–515.CrossRefPubMedGoogle Scholar
  58. 58.
    Guyatt, G. H., Norman, G. R., Juniper, E. F., & Griffith, L. E. (2002). A critical look at transition ratings. Journal of Clinical Epidemiology, 55(9), 900–908.CrossRefPubMedGoogle Scholar
  59. 59.
    Schmitt, J., & Di Fabio, R. P. (2005). The validity of prospective and retrospective global change criterion measures. Archives of Physical Medicine and Rehabilitation, 86(12), 2270–2276.CrossRefPubMedGoogle Scholar
  60. 60.
    Kamper, S. J., Ostelo, R. W., Knol, D. L., Maher, C. G., de Vet, H. C., & Hancock, M. J. (2010). Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. Journal of Clinical Epidemiology, 63(7), 760–766.CrossRefPubMedGoogle Scholar
  61. 61.
    Tubach, F., Dougados, M., Falissard, B., Baron, G., Logeart, I., & Ravaud, P. (2006). Feeling good rather than feeling better matters more to patients. Arthritis and Rheumatism, 55(4), 526–530.CrossRefPubMedGoogle Scholar
  62. 62.
    Barrett, B., Brown, D., Mundt, M., & Brown, R. (2005). Sufficiently important difference: Expanding the framework of clinical significance. Medical Decision Making, 25(3), 250–261.CrossRefPubMedGoogle Scholar
  63. 63.
    Salt, E., & Peden, A. (2011). The complexity of the treatment: The decision-making process among women with rheumatoid arthritis. Qualitative Health Research, 21(2), 214–222.CrossRefPubMedGoogle Scholar
  64. 64.
    de Achaval, S., & Suarez-Almazor, M. E. (2010). Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. International Journal of Clinical Rheumatology, 5(3), 313–326.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Barton, J. L. (2009). Patient preferences and satisfaction in the treatment of rheumatoid arthritis with biologic therapy. Patient Preference and Adherence, 3, 335–344.CrossRefPubMedCentralPubMedGoogle Scholar
  66. 66.
    Sinclair, V. G., & Blackburn, D. S. (2008). Adaptive coping with rheumatoid arthritis: The transforming nature of response shift. Chronic Illness, 4(3), 219–230.CrossRefPubMedGoogle Scholar
  67. 67.
    Martin, R. W., Head, A. J., Rene, J., Swartz, T. J., Fiechtner, J. J., McIntosh, B. A., et al. (2008). Patient decision-making related to antirheumatic drugs in rheumatoid arthritis: The importance of patient trust of physician. Journal of Rheumatology, 35(4), 618–624.PubMedGoogle Scholar
  68. 68.
    Fraenkel, L., Bogardus, S. T., Concato, J., Felson, D. T., & Wittink, D. R. (2004). Patient preferences for treatment of rheumatoid arthritis. Annals of the Rheumatic Diseases, 63(11), 1372–1378.CrossRefPubMedCentralPubMedGoogle Scholar
  69. 69.
    Fraenkel, L., Bogardus, S., Concato, J., & Felson, D. (2003). Risk communication in rheumatoid arthritis. Journal of Rheumatology, 30(3), 443–448.PubMedGoogle Scholar
  70. 70.
    Ferreira, M. L., Ferreira, P. H., Herbert, R. D., & Latimer, J. (2009). People with low back pain typically need to feel ‘much better’ to consider intervention worthwhile: An observational study. Australian Journal of Physiotherapy, 55(2), 123–127.CrossRefPubMedGoogle Scholar
  71. 71.
    Barrett, B., Brown, R., Mundt, M., Dye, L., Alt, J., Safdar, N., et al. (2005). Using benefit harm tradeoffs to estimate sufficiently important difference: The case of the common cold. Medical Decision Making, 25(1), 47–55.CrossRefPubMedGoogle Scholar
  72. 72.
    Barrett, B. (2013). Sufficiently important difference: Concepts, caveats, and challenges. Medical Decision Making, 33(6), 869–874.CrossRefPubMedGoogle Scholar
  73. 73.
    Strand, V., Boers, M., Idzerda, L., Kirwan, J. R., Kvien, T. K., Tugwell, P. S., et al. (2011). It’s good to feel better but it’s better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. Journal of Rheumatology, 38(8), 1720–1727.CrossRefPubMedGoogle Scholar
  74. 74.
    Dougados, M. (2005). It’s good to feel better but it’s better to feel good. Journal of Rheumatology, 32(1), 1–2.PubMedGoogle Scholar
  75. 75.
    Heiberg, T., Kvien, T. K., Mowinckel, P., Aletaha, D., Smolen, J. S., & Hagen, K. B. (2008). Identification of disease activity and health status cut-off points for the symptom state acceptable to patients with rheumatoid arthritis. Annals of the Rheumatic Diseases, 67(7), 967–971.CrossRefPubMedGoogle Scholar
  76. 76.
    Wolfe, F., & Michaud, K. (2009). Proposed metrics for the determination of rheumatoid arthritis outcome and treatment success and failure. Journal of Rheumatology, 36(1), 27–33.PubMedGoogle Scholar
  77. 77.
    Paulsen, A., Roos, E. M., Pedersen, A. B., & Overgaard, S. (2014). Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthopaedica, 85(1), 39–48.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Jos Hendrikx
    • 1
  • Jaap Fransen
    • 1
  • Wietske Kievit
    • 2
  • Piet L. C. M. van Riel
    • 3
  1. 1.Department of Rheumatology (470)Radboud University Medical CenterNijmegenThe Netherlands
  2. 2.Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
  3. 3.Scientific Institute for Quality of HealthcareRadboud University Medical CenterNijmegenThe Netherlands

Personalised recommendations