Supportive Care in Cancer

, Volume 18, Issue 3, pp 307–315

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population

  • Amanda Purcell
  • Jennifer Fleming
  • Sally Bennett
  • Bryan Burmeister
  • Terry Haines
Original Article

DOI: 10.1007/s00520-009-0653-z

Cite this article as:
Purcell, A., Fleming, J., Bennett, S. et al. Support Care Cancer (2010) 18: 307. doi:10.1007/s00520-009-0653-z



The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient’s fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population.

Materials and methods

Two hundred ten patients undergoing radiotherapy were recruited to a single-centre prospective cohort study. Patients were assessed at three time points, at the start of radiotherapy, the end of radiotherapy and 6 weeks after radiotherapy completion. Assessment consisted of four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine MCIDs for each sub-scale of the MFI.


Multiple MCIDs were identified, each from a different perspective based on the constructs cited. Researchers seeking to use a generic MCID may wish to use a two-point reference for each MFI sub-scale as it was consistent across the pre- and post-radiotherapy comparison and occupational productivity anchors.


MCIDs validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies.


Cancer-related fatigue Minimal clinically important difference Multidimensional fatigue inventory Utility Anchor-based methods Distribution-based methods 



Multidimensional Fatigue Inventory


minimal clinically important difference

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Amanda Purcell
    • 1
    • 2
  • Jennifer Fleming
    • 1
    • 2
  • Sally Bennett
    • 3
  • Bryan Burmeister
    • 4
  • Terry Haines
    • 5
    • 6
  1. 1.School of Health and Rehabilitation SciencesThe Univeristy of QueenslandBrisbaneAustralia
  2. 2.Occupational TherapyPrincess Alexandra HospitalBrisbaneAustralia
  3. 3.School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
  4. 4.Radiation OncologyPrincess Alexandra HospitalBrisbaneAustralia
  5. 5.Clinical Research, Southern Physiotherapy SchoolMonash UniversityClaytonAustralia
  6. 6.Allied Health Clinical Research, Continuing Care, Southern HealthCheltenhamAustralia