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28-07-2021 | Review

Triangulation of multiple meaningful change thresholds for patient-reported outcome scores

Auteurs: Andrew Trigg, Pip Griffiths

Gepubliceerd in: Quality of Life Research | Uitgave 10/2021

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Abstract

Purpose

The notion of what constitutes meaningful differences or changes in patient-reported outcome scores is represented by meaningful change thresholds (MCTs). Applying multiple methods to estimate MCTs inevitably results in a range of estimates; however, a single estimate or small range is sought in practice to enable consistent interpretation of scores. While current recommendations for triangulation are appropriate in principle, the vital step of moving from all estimates to a value or small range lacks clarity and is subjective in nature. This article aims to review current triangulation approaches and provide more robust recommendations than what is currently available.

Methods

Current approaches to perform triangulation are described and discussed. Anchor-based estimates are focussed upon due to their recognition as the most valid and developed approach. Recommendations for triangulation are provided.

Results

A correlation-weighted average of MCT estimates is recommended to triangulate multiple MCT estimates derived from a single study into a single value, where increased weighting is given to stronger anchor measures. The choice of method to triangulate estimates from several published studies is highly dependent on the availability of information within the publications. MCTs designed for between-group differences, within-group changes, and within-individual changes should be considered separately.

Conclusion

The recommendations within this article provide a reliable and transparent approach to triangulation when a single value is sought, based on meta-analytic approaches. This approach is preferable to a simple mean of estimates where all are weighted equally, or through ‘eyeballing’ plotted estimates which is unreliable. We encourage researchers to adopt these methods, but to remain aware of the limitations within each method and further nuances in study design that result in heterogeneity. Sensitivity analyses with a range of plausible values are encouraged; however, the recommendations provide a suitable starting value for inferences. Unresolved issues in triangulation, requiring further exploration, are highlighted.
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Literatuur
1.
go back to reference King, M. T. (2011). A point of minimal important difference (MID): A critique of terminology and methods. Expert Review of Pharmacoeconomics & Outcomes Research, 11(2), 171–184.CrossRef King, M. T. (2011). A point of minimal important difference (MID): A critique of terminology and methods. Expert Review of Pharmacoeconomics & Outcomes Research, 11(2), 171–184.CrossRef
4.
go back to reference Cocks, K., King, M. T., Velikova, G., de Castro, G., Jr., Martyn St-James, M., Fayers, P. M., et al. (2012). Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. European Journal of Cancer, 48(11), 1713–1721. https://doi.org/10.1016/j.ejca.2012.02.059CrossRefPubMed Cocks, K., King, M. T., Velikova, G., de Castro, G., Jr., Martyn St-James, M., Fayers, P. M., et al. (2012). Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. European Journal of Cancer, 48(11), 1713–1721. https://​doi.​org/​10.​1016/​j.​ejca.​2012.​02.​059CrossRefPubMed
5.
go back to reference Musoro, J. Z., Bottomley, A., Coens, C., Eggermont, A. M., King, M. T., Cocks, K., et al. (2018). Interpreting European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 scores as minimally importantly different for patients with malignant melanoma. European Journal of Cancer, 104, 169–181. https://doi.org/10.1016/j.ejca.2018.09.005CrossRefPubMed Musoro, J. Z., Bottomley, A., Coens, C., Eggermont, A. M., King, M. T., Cocks, K., et al. (2018). Interpreting European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 scores as minimally importantly different for patients with malignant melanoma. European Journal of Cancer, 104, 169–181. https://​doi.​org/​10.​1016/​j.​ejca.​2018.​09.​005CrossRefPubMed
9.
go back to reference Coon, C. D., & Cappelleri, J. C. (2016). Interpreting change in scores on patient-reported outcome instruments. Therapeutic Innovation & Regulatory Science, 50(1), 22–29.CrossRef Coon, C. D., & Cappelleri, J. C. (2016). Interpreting change in scores on patient-reported outcome instruments. Therapeutic Innovation & Regulatory Science, 50(1), 22–29.CrossRef
10.
go back to reference Messick, S. (1989). Meaning and values in test validation: The science and ethics of assessment. Educational Researcher, 18(2), 5–11.CrossRef Messick, S. (1989). Meaning and values in test validation: The science and ethics of assessment. Educational Researcher, 18(2), 5–11.CrossRef
11.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
12.
go back to reference Staunton, H., Willgoss, T., Nelsen, L., Burbridge, C., Sully, K., Rofail, D., et al. (2019). An overview of using qualitative techniques to explore and define estimates of clinically important change on clinical outcome assessments. Journal of Patient-Reported Outcomes, 3(1), 1–10.CrossRef Staunton, H., Willgoss, T., Nelsen, L., Burbridge, C., Sully, K., Rofail, D., et al. (2019). An overview of using qualitative techniques to explore and define estimates of clinically important change on clinical outcome assessments. Journal of Patient-Reported Outcomes, 3(1), 1–10.CrossRef
14.
go back to reference Lord, F. M., Novick, M. R., & Birnbaum, A. (1968). Statistical theories of mental test scores. Addison-Wesley. Lord, F. M., Novick, M. R., & Birnbaum, A. (1968). Statistical theories of mental test scores. Addison-Wesley.
16.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
25.
go back to reference Schwind, J., Learman, K., O’Halloran, B., Showalter, C., & Cook, C. (2013). Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients. Journal of Manual & Manipulative Therapy, 21(2), 71–78. https://doi.org/10.1179/2042618613Y.0000000028CrossRef Schwind, J., Learman, K., O’Halloran, B., Showalter, C., & Cook, C. (2013). Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients. Journal of Manual & Manipulative Therapy, 21(2), 71–78. https://​doi.​org/​10.​1179/​2042618613Y.​0000000028CrossRef
27.
go back to reference Wyrwich, K. W., Metz, S. M., Kroenke, K., Tierney, W. M., Babu, A. N., & Wolinsky, F. D. (2007). Triangulating patient and clinician perspectives on clinically important differences in health-related quality of life among patients with heart disease. Health Services research, 42(6p1), 2257–2274.CrossRefPubMedPubMedCentral Wyrwich, K. W., Metz, S. M., Kroenke, K., Tierney, W. M., Babu, A. N., & Wolinsky, F. D. (2007). Triangulating patient and clinician perspectives on clinically important differences in health-related quality of life among patients with heart disease. Health Services research, 42(6p1), 2257–2274.CrossRefPubMedPubMedCentral
32.
go back to reference Harper, A., Trennery, C., Sully, K., & Trigg, A. (2018). Triangulating estimates of meaningful change or difference in patient-reported outcomes: Application of a correlation-based weighting procedure. Quality of Life Research, 27, S17. Harper, A., Trennery, C., Sully, K., & Trigg, A. (2018). Triangulating estimates of meaningful change or difference in patient-reported outcomes: Application of a correlation-based weighting procedure. Quality of Life Research, 27, S17.
33.
go back to reference Sully, K., Trigg, A., Bonner, N., Moreno-Koehler, A., Trennery, C., Shah, N., et al. (2019). Estimation of minimally important differences and responder definitions for EORTC QLQ-MY20 scores in multiple myeloma patients. European Journal of Haematology, 103(5), 500–509.CrossRefPubMedPubMedCentral Sully, K., Trigg, A., Bonner, N., Moreno-Koehler, A., Trennery, C., Shah, N., et al. (2019). Estimation of minimally important differences and responder definitions for EORTC QLQ-MY20 scores in multiple myeloma patients. European Journal of Haematology, 103(5), 500–509.CrossRefPubMedPubMedCentral
36.
go back to reference Fisher, R. A. (1934). Statistical methods for research workers (5th ed.). Springer. Fisher, R. A. (1934). Statistical methods for research workers (5th ed.). Springer.
37.
go back to reference Jacobs, P., & Viechtbauer, W. (2017). Estimation of the biserial correlation and its sampling variance for use in meta-analysis. Research Synthesis Methods, 8(2), 161–180.CrossRefPubMed Jacobs, P., & Viechtbauer, W. (2017). Estimation of the biserial correlation and its sampling variance for use in meta-analysis. Research Synthesis Methods, 8(2), 161–180.CrossRefPubMed
41.
go back to reference Devji, T., Guyatt, G. H., Lytvyn, L., Brignardello-Petersen, R., Foroutan, F., Sadeghirad, B., et al. (2017). Application of minimal important differences in degenerative knee disease outcomes: A systematic review and case study to inform BMJ Rapid Recommendations. British Medical Journal Open, 7(5), e015587. https://doi.org/10.1136/bmjopen-2016-015587CrossRef Devji, T., Guyatt, G. H., Lytvyn, L., Brignardello-Petersen, R., Foroutan, F., Sadeghirad, B., et al. (2017). Application of minimal important differences in degenerative knee disease outcomes: A systematic review and case study to inform BMJ Rapid Recommendations. British Medical Journal Open, 7(5), e015587. https://​doi.​org/​10.​1136/​bmjopen-2016-015587CrossRef
42.
go back to reference Hao, Q., Devji, T., Zeraatkar, D., Wang, Y., Qasim, A., Siemieniuk, R. A. C., et al. (2019). Minimal important differences for improvement in shoulder condition patient-reported outcomes: A systematic review to inform a BMJ Rapid Recommendation. British Medical Journal Open, 9(2), e028777. https://doi.org/10.1136/bmjopen-2018-028777CrossRef Hao, Q., Devji, T., Zeraatkar, D., Wang, Y., Qasim, A., Siemieniuk, R. A. C., et al. (2019). Minimal important differences for improvement in shoulder condition patient-reported outcomes: A systematic review to inform a BMJ Rapid Recommendation. British Medical Journal Open, 9(2), e028777. https://​doi.​org/​10.​1136/​bmjopen-2018-028777CrossRef
44.
go back to reference Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis. Wiley.CrossRef Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis. Wiley.CrossRef
49.
go back to reference Cocks, K., & Buchanan, J. (2015). Defining responders on the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (30-item core module)(QLQ-C30) subscales. Quality of Life Research, 24, 125. Cocks, K., & Buchanan, J. (2015). Defining responders on the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (30-item core module)(QLQ-C30) subscales. Quality of Life Research, 24, 125.
53.
Metagegevens
Titel
Triangulation of multiple meaningful change thresholds for patient-reported outcome scores
Auteurs
Andrew Trigg
Pip Griffiths
Publicatiedatum
28-07-2021
Uitgeverij
Springer International Publishing
Gepubliceerd in
Quality of Life Research / Uitgave 10/2021
Print ISSN: 0962-9343
Elektronisch ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-021-02957-4

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