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Minimal important change and minimal detectable change in activities of daily living in community-living older people

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The journal of nutrition, health & aging

Abstract

Objective

To estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale.

Design

Data from a cluster-randomized clinical trial and a cohort study.

Setting

General practices in the Netherlands.

Participants

3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years.

Measurements

At baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method.

Results

Anchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed.

Conclusion

The MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.

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References

  1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. The journals of gerontology Series A, Biological sciences and medical sciences. 2004;59(3):255–63.

    Article  PubMed  Google Scholar 

  2. Fried TR, Tinetti ME, Iannone L, O’Leary JR, Towle V, Van Ness PH. Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Archives of internal medicine. 2011;171(20):1854–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gill TM. Assessment of function and disability in longitudinal studies. Journal of the American Geriatrics Society. 2010;58 Suppl 2:S308–12.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Laan W, Zuithoff NP, Drubbel I, Bleijenberg N, Numans ME, de Wit NJ, et al. Validity and reliability of the katz-15 scale to measure unfavorable health outcomes in community-dwelling older people. The journal of nutrition, health & aging. 2014;18(9):848–54.

    Article  CAS  Google Scholar 

  5. de Vet HC. Measurements in Medicine Cambridge university press; 2011.

    Google Scholar 

  6. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Controlled clinical trials. 1989;10(4):407–15.

    Article  CAS  PubMed  Google Scholar 

  7. Schunemann HJ, Guyatt GH. Commentary—goodbye M(C)ID! Hello MID, where do you come from? Health services research. 2005;40(2):593–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Man-Son-Hing M, Laupacis A, O’Rourke K, Molnar FJ, Mahon J, Chan KB, et al. Determination of the clinical importance of study results. Journal of general internal medicine. 2002;17(6):469–76.

    Article  PubMed  PubMed Central  Google Scholar 

  9. de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health and quality of life outcomes. 2006;4:54.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Suijker JJ, Buurman BM, ter Riet G, van Rijn M, de Haan RJ, de Rooij SE, et al. Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial. BMC health services research. 2012;12:85.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Askari M, Eslami S, van Rijn M, Medlock S, van Charante EP, van der Velde N, et al. Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators. Osteoporos Int. 2015.

    Google Scholar 

  12. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function. JAMA: the journal of the American Medical Association. 1963;185:914–9.

    Article  CAS  PubMed  Google Scholar 

  13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179–86.

    Article  CAS  PubMed  Google Scholar 

  14. EuroQol—a new facility for the measurement of health-related quality of life. Health policy (Amsterdam, Netherlands). 1990;16(3):199–208.

  15. Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. Journal of clinical epidemiology. 1998;51(11):1055–68.

    Article  CAS  PubMed  Google Scholar 

  16. Terwee CB, Roorda LD, Dekker J, Bierma-Zeinstra SM, Peat G, Jordan KP, et al. Mind the MIC: large variation among populations and methods. Journal of clinical epidemiology. 2010;63(5):524–34.

    Article  PubMed  Google Scholar 

  17. Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of clinical epidemiology. 2008;61(2):102–9.

    Article  PubMed  Google Scholar 

  18. Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. Journal of clinical epidemiology. 2003;56(5):395–407.

    Article  PubMed  Google Scholar 

  19. Leidy NK, Wyrwich KW. Bridging the gap: using triangulation methodology to estimate minimal clinically important differences (MCIDs). Copd. 2005;2(1):157–65.

    Article  PubMed  Google Scholar 

  20. Cohen J. Statistical Power Analysis for the Behaviour Sciences.. New Jersey: Lawrence Earlbaum; 1988.

    Google Scholar 

  21. Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEMbased criterion for identifying meaningful intra-individual changes in health-related quality of life. Journal of clinical epidemiology. 1999;52(9):861–73.

    Article  CAS  PubMed  Google Scholar 

  22. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical care. 2003;41(5):582–92.

    PubMed  Google Scholar 

  23. Yost KJ, Cella D, Chawla A, Holmgren E, Eton DT, Ayanian JZ, et al. Minimally important differences were estimated for the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) instrument using a combination of distribution-and anchor-based approaches. Journal of clinical epidemiology. 2005;58(12):1241–51.

    Article  CAS  PubMed  Google Scholar 

  24. Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ, et al. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study). The journal of nutrition, health & aging. 2009;13(6):538–44.

    Article  CAS  Google Scholar 

  25. Moons KG, Donders RA, Stijnen T, Harrell FE, Jr. Using the outcome for imputation of missing predictor values was preferred. Journal of clinical epidemiology. 2006;59(10):1092–101.

    Article  PubMed  Google Scholar 

  26. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of clinical epidemiology. 2007;60(1):34–42.

    Article  PubMed  Google Scholar 

  27. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society. 2006;54(5):743–9.

    Article  PubMed  Google Scholar 

  28. Davenport SJ, de Morton NA. Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults. Archives of physical medicine and rehabilitation. 2011;92(1):51–8.

    Article  PubMed  Google Scholar 

  29. Beauchamp MK, Jette AM, Ward RE, Kurlinski LA, Kiely D, Latham NK, et al. Predictive validity and responsiveness of patient-reported and performance-based measures of function in the Boston RISE study. The journals of gerontology Series A, Biological sciences and medical sciences. 2015;70(5):616–22.

    Article  PubMed  Google Scholar 

  30. Hebert R, Spiegelhalter DJ, Brayne C. Setting the minimal metrically detectable change on disability rating scales. Archives of physical medicine and rehabilitation. 1997;78(12):1305–8.

    Article  CAS  PubMed  Google Scholar 

  31. Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. Journal of chronic diseases. 1986;39(11):897–906.

    Article  CAS  PubMed  Google Scholar 

  32. Terluin B, Eekhout I, Terwee CB, de Vet HC. Minimal important change (MIC) based on a predictive modeling approach was more precise than MIC based on ROC analysis. Journal of clinical epidemiology. 2015.

    Google Scholar 

  33. Mullis R, Lewis M, Hay EM. What does minimal important change mean to patients? Associations between individualized goal attainment scores and disability, general health status and global change in condition. J Eval Clin Pract. 2011;17(2):244–50.

    Article  PubMed  Google Scholar 

  34. Wright JG. The minimal important difference: who’s to say what is important? Journal of clinical epidemiology. 1996;49(11):1221–2.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of General Practice & Public Health, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Jacqueline J. Suijker, G. ter Riet & E. P. Moll van Charante

  2. Departments of Internal Medicine, section of Geriatric Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands

    M. van Rijn, S. E. de Rooij & B. M. Buurman

  3. University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands

    S. E. de Rooij

Authors
  1. Jacqueline J. Suijker
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  2. M. van Rijn
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  3. G. ter Riet
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  4. E. P. Moll van Charante
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  5. S. E. de Rooij
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  6. B. M. Buurman
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Correspondence to Jacqueline J. Suijker.

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Suijker, J.J., van Rijn, M., ter Riet, G. et al. Minimal important change and minimal detectable change in activities of daily living in community-living older people. J Nutr Health Aging 21, 165–172 (2017). https://doi.org/10.1007/s12603-016-0797-8

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  • DOI: https://doi.org/10.1007/s12603-016-0797-8

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