ISSN 1302-6631
 

Invited Review 


Minimal clinically important difference approach and its application in psychiatry

Cengiz Han Açıkel.

Abstract
After Fisher's introduce of p-value and the cut-off point of 0.05, all clinical studies were evaluated with the statistical significance of the findings. Although the p-value is an objective result but has two important shortfalls. First, although there are significant differences, it has not been found due to insufficient sample size (type II error), and the other is that some statistically significant differences are not clinically important. Minimal clinically important difference (MCID) approach deals with the question of whether the difference is clinically important. MCID concept was described first in 1989 by Jaeschke et al. Although there were statistically significant differences in the use of tools to measure change after treatment, there were no clinically significant differences and they tried to determine the smallest level of clinically significant change. This concept basically includes two elements: 1. the smallest differ-ence that the patient indicates as a change, and 2. the smallest difference that will change the patients’ treatment approach. In this article, we tried to summarize the MCID approach, describe commonly used methods and briefly explain its application in psychiatry, to evaluate clinical efficacy in the use of patient-reported outcomes.

Key words: minimal clinically important difference, MCID, minimal important difference, MID, patient reported out-come measures



En küçük klinik önemli değişim yaklaşımı ve psikiyatride kullanımı

Ozet
Fisher’in p değeri ve 0.05 kesim noktasını tanımlamasından sonra tüm klinik araştırmalar sonuçların istatistiksel olarak anlamlı olup olmaması ile değerlendirilmeye başlanmıştır. p değeri nesnel bir sonuç göstermesine karşın, iki önemli yanılgıya sahiptir. İlki, önemli bir fark olmasına karşın yeterli bir örnek büyüklüğünde çalışılmamış olmasın-dan kaynaklanan fark bulamama (tip II hata), diğeri istatistiksel olarak anlamlı olan farkın aslında hasta için anlamlı bir değişiklik oluşturmamasıdır. En küçük klinik önemli değişim (minimal clinically important difference-MCID) yakla-şımı, oluşan farkın klinik olarak önemli olup olmaması sorunu ile ilgilenir. En küçük klinik önemli değişim kavramı ilk olarak 1989’da Jaeschke ve arkadaşları tarafından tanımlanmıştır. Tedavi sonrası değişimi ölçen araçların kulla-nımı sırasında, sıklıkla istatistiksel olarak anlamlı değişiklikler saptanmasına karşın, klinik olarak anlamlı fark görül-mediğini belirtmiş ve klinik olarak önemli en küçük değişim düzeyini belirlemeye çalışmışlardır. Bu kavram temelde iki öğeyi içerir: 1. Hastanın değişiklik olarak belirttiği en küçük değişimi, 2. Hastanın tedavi yaklaşımını değiştirecek en küçük değişim. Bu yazıda, hasta bildirimine dayalı gidiş ölçütlerinin kullanımında klinik etkinliği değerlendirmek üzere başvurulabilecek en küçük klinik önemli değişim yaklaşımını özetlemeye, sık kullanılan hesaplama yöntem-lerini tanımlamaya ve psikiyatrideki olası kullanımını açıklamaya çalıştık.

Anahtar Kelimeler: En küçük klinik önemli değişim, MCID, en küçük önemli değişim, MID, hasta bildirimine dayalı gidiş ölçütleri


 
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Pubmed Style

Cengiz Han Acikel. [Minimal clinically important difference approach and its application in psychiatry]. Anadolu Psikiyatri Derg. 2019; 20(3): 327-332. . doi:10.5455/apd.302644228


Web Style

Cengiz Han Acikel. [Minimal clinically important difference approach and its application in psychiatry]. http://www.anadolupsikiyatri.net/?mno=302644228 [Access: July 20, 2019]. . doi:10.5455/apd.302644228


AMA (American Medical Association) Style

Cengiz Han Acikel. [Minimal clinically important difference approach and its application in psychiatry]. Anadolu Psikiyatri Derg. 2019; 20(3): 327-332. . doi:10.5455/apd.302644228



Vancouver/ICMJE Style

Cengiz Han Acikel. [Minimal clinically important difference approach and its application in psychiatry]. Anadolu Psikiyatri Derg. (2019), [cited July 20, 2019]; 20(3): 327-332. . doi:10.5455/apd.302644228



Harvard Style

Cengiz Han Acikel (2019) [Minimal clinically important difference approach and its application in psychiatry]. Anadolu Psikiyatri Derg, 20 (3), 327-332. . doi:10.5455/apd.302644228



Turabian Style

Cengiz Han Acikel. 2019. [Minimal clinically important difference approach and its application in psychiatry]. Anatolian Journal of Psychiatry, 20 (3), 327-332. . doi:10.5455/apd.302644228



Chicago Style

Cengiz Han Acikel. "[Minimal clinically important difference approach and its application in psychiatry]." Anatolian Journal of Psychiatry 20 (2019), 327-332. . doi:10.5455/apd.302644228



MLA (The Modern Language Association) Style

Cengiz Han Acikel. "[Minimal clinically important difference approach and its application in psychiatry]." Anatolian Journal of Psychiatry 20.3 (2019), 327-332. Print.. doi:10.5455/apd.302644228



APA (American Psychological Association) Style

Cengiz Han Acikel (2019) [Minimal clinically important difference approach and its application in psychiatry]. Anatolian Journal of Psychiatry, 20 (3), 327-332. . doi:10.5455/apd.302644228





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