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J Clin Epidemiol. 2012 Mar;65(3):253-61. doi: 10.1016/j.jclinepi.2011.06.018. Epub 2011 Oct 19.

A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain.

Author information

1
The George Institute for Global Health, Missenden Road, NSW 2050, Australia. mferreira@george.org.au

Abstract

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.

PMID:
22014888
DOI:
10.1016/j.jclinepi.2011.06.018
[Indexed for MEDLINE]

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