TY - JOUR
T1 - A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain
AU - Ferreira, M.L.
AU - Herbert, R.D.
AU - Ferreira, P.H.
AU - Latimer, J.
AU - Ostelo, R.W.J.G.
AU - Nascimento, D.P.
AU - Smeets, R.J.
PY - 2012
Y1 - 2012
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. © 2012 Elsevier Inc. All rights reserved.
AB - 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. © 2012 Elsevier Inc. All rights reserved.
U2 - 10.1016/j.jclinepi.2011.06.018
DO - 10.1016/j.jclinepi.2011.06.018
M3 - Article
SN - 0895-4356
VL - 65
SP - 253
EP - 261
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 3
ER -