Document Detail

Minimal clinically important difference in radiological progression of joint damage over 1 year in rheumatoid arthritis: preliminary results of a validation study with clinical experts.
MedLine Citation:
PMID:  11327274     Owner:  NLM     Status:  MEDLINE    
To determine the minimal clinically important difference (MCID) between hand and foot films with a 1 year interval assessed with the Sharp/van der Heijde or Larsen/Scott scoring method. Progression scores of the 2 methods were compared with the opinion of an international expert panel on clinical relevance of radiological joint damage in 4 predefined clinical settings. The expert panel consisted of 3 rheumatologists, who evaluated 46 pairs of hand and foot films, taken with 1 year intervals, of patients with early rheumatoid arthritis. Receiver operating characteristics curves analyzed the accuracy of different threshold values (progression scores) of the 2 scoring methods to detect the presence or absence of clinically important difference, as defined by the expert panel as external criterion. The threshold value with the highest accuracy was subsequently chosen as the score representing the MCID. Five Sharp/van der Heijde units and 2 Larsen/Scott units were the best cutoffs. The accompanying sensitivities ranged from 77% to 100% for the Sharp/van der Heijde method and from 73% to 84% for the Larsen/Scott method for the 4 clinical settings. The specificities were between 78% and 84% for the Sharp/van der Heijde method and between 74% and 94% for the Larsen/Scott method. The smallest progression score that can be detected apart from interobserver measurement error, the smallest detectable difference (SDD), was equal to or larger than the calculated MCID, 5 Sharp/van der Heijde units and 6 Larsen/Scott units in our study, if the mean progression scores of the same 2 observers were used. The SDD is a conservative estimate of the MCID; our panel rated progression at or below this level as clinically significant.
K Bruynesteyn; D van der Heijde; M Boers; M Lassere; A Boonen; J Edmonds; H Houben; H Paulus; P Peloso; A Saudan; S van der Linden
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  The Journal of rheumatology     Volume:  28     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-30     Completed Date:  2001-08-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  904-10     Citation Subset:  IM    
Department of Rheumatology, University Hospital Maastricht, The Netherlands.
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MeSH Terms
Arthritis, Rheumatoid / radiography*
Arthrography / methods*
Disease Progression
Expert Testimony
Observer Variation
ROC Curve
Reproducibility of Results
Sensitivity and Specificity
Single-Blind Method

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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