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      Minimal clinically important difference for daily pedometer step count in COPD

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          Abstract

          Assessment of physical activity is an important part of COPD management, because physical inactivity is associated with mortality and morbidity in this disease group [1]. The most commonly used physical activity outcome is daily step count, typically measured using an accelerometer or pedometer [2]. Outside the research arena, pedometers are used more commonly than accelerometers due to lower cost, simplicity and acceptability to patients. Although previous studies have described the minimal clinically important difference (MCID) in accelerometer daily step count, these estimates are not appropriate for the interpretation of meaningful changes in pedometer step count, as pedometers are less reliable in capturing daily step count [3]. The MCID for improvement in daily pedometer step count in patients with COPD undergoing pulmonary rehabilitation is not known, and there are limited data on MCID for deterioration in pedometer step count. The aim of our study was to provide an estimate of the MCID for daily pedometer step count in patients with COPD, using response to pulmonary rehabilitation as a model of improvement and longitudinal decline following pulmonary rehabilitation as a model of deterioration.

          Abstract

          Pedometer step count improves with pulmonary rehabilitation and deteriorates with time. The MCID for improvement and deterioration is 427 and −456 steps, respectively, but there is uncertainty about the reliability of these estimates. https://bit.ly/3ci97Jh

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          Determining a minimal important change in a disease-specific Quality of Life Questionnaire.

          This study was carried out to determine whether the minimal important difference, in evaluative quality of life instruments which use a 7-point scale, is similar across individual domains and for both improvement and deterioration. Thirty nine adults with asthma were studied, using an 8 week cohort with assessments at 0, 4 and 8 weeks. The outcomes were the Asthma Quality of Life Questionnaire and global rating of change. For overall asthma-specific quality of life and for all individual domains (activities, emotions, symptoms), the minimal important difference of quality of life score per item was very close to 0.5 (range: 0.42-0.58); differences of approximately 1.0 represented a moderate change (range: 0.77-1.51); differences greater than 1.5 represented large changes. Changes for improvement and deterioration were very similar. The changes in quality of life score that represent a minimal important difference are very similar to those observed for other evaluative instruments. The observation that the minimal important difference is consistent across domains and for both improvement and deterioration will facilitate interpretation of results of studies examining quality of life.
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            Minimum clinically important difference for the COPD Assessment Test: a prospective analysis.

            The COPD Assessment Test (CAT) is responsive to change in patients with chronic obstructive pulmonary disease (COPD). However, the minimum clinically important difference (MCID) has not been established. We aimed to identify the MCID for the CAT using anchor-based and distribution-based methods. We did three studies at two centres in London (UK) between April 1, 2010, and Dec 31, 2012. Study 1 assessed CAT score before and after 8 weeks of outpatient pulmonary rehabilitation in patients with COPD who were able to walk 5 m, and had no contraindication to exercise. Study 2 assessed change in CAT score at discharge and after 3 months in patients admitted to hospital for more than 24 h for acute exacerbation of COPD. Study 3 assessed change in CAT score at baseline and at 12 months in stable outpatients with COPD. We focused on identifying the minimum clinically important improvement in CAT score. The St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ) were measured concurrently as anchors. We used receiver operating characteristic curves, linear regression, and distribution-based methods (half SD, SE of measurement) to estimate the MCID for the CAT; we included only patients with paired CAT scores in the analysis. In Study 1, 565 of 675 (84%) patients had paired CAT scores. The mean change in CAT score with pulmonary rehabilitation was -2·5 (95% CI -3·0 to -1·9), which correlated significantly with change in SGRQ score (r=0·32; p<0·0001) and CRQ score (r=-0·46; p<0·0001). In Study 2, of 200 patients recruited, 147 (74%) had paired CAT scores. Mean change in CAT score from hospital discharge to 3 months after discharge was -3·0 (95% CI -4·4 to -1·6), which correlated with change in SGRQ score (r=0·47; p<0·0001). In Study 3, of 200 patients recruited, 164 (82%) had paired CAT scores. Although no significant change in CAT score was identified after 12 months (mean 0·6, 95% CI -0·4 to 1·5), change in CAT score correlated significantly with change in SGRQ score (r=0·36; p<0·0001). Linear regression estimated the minimum clinically important improvement for the CAT to range between -1·2 and -2·8 with receiver operating characteristic curves consistently identifying -2 as the MCID. Distribution-based estimates for the MCID ranged from -3·3 to -3·8. The most reliable estimate of the minimum important difference of the CAT is 2 points. This estimate could be useful in the clinical interpretation of CAT data, particularly in response to intervention studies. Medical Research Council and UK National Institute of Health Research. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              The Minimal Important Difference in Physical Activity in Patients with COPD

              Background Changes in physical activity (PA) are difficult to interpret because no framework of minimal important difference (MID) exists. We aimed to determine the minimal important difference (MID) in physical activity (PA) in patients with Chronic Obstructive Pulmonary Disease and to clinically validate this MID by evaluating its impact on time to first COPD-related hospitalization. Methods PA was objectively measured for one week in 74 patients before and after three months of rehabilitation (rehabilitation sample). In addition the intraclass correlation coefficient was measured in 30 patients (test-retest sample), by measuring PA for two consecutive weeks. Daily number of steps was chosen as outcome measurement. Different distribution and anchor based methods were chosen to calculate the MID. Time to first hospitalization due to an exacerbation was compared between patients exceeding the MID and those who did not. Results Calculation of the MID resulted in 599 (Standard Error of Measurement), 1029 (empirical rule effect size), 1072 (Cohen's effect size) and 1131 (0.5SD) steps.day-1. An anchor based estimation could not be obtained because of the lack of a sufficiently related anchor. The time to the first hospital admission was significantly different between patients exceeding the MID and patients who did not, using the Standard Error of Measurement as cutoff. Conclusions The MID after pulmonary rehabilitation lies between 600 and 1100 steps.day-1. The clinical importance of this change is supported by a reduced risk for hospital admission in those patients with more than 600 steps improvement.
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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                January 2021
                22 March 2021
                : 7
                : 1
                : 00823-2020
                Affiliations
                [1 ]Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
                [2 ]National Heart and Lung Institute, Imperial College London, London, UK
                [3 ]Hillingdon Integrated Respiratory Service, Hillingdon Hospitals NHS Foundation Trust, London, UK
                [4 ]Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
                Author notes
                Claire M. Nolan, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UB9 6JH, UK. E-mail: c.nolan@ 123456rbht.nhs.uk
                Author information
                https://orcid.org/0000-0002-1320-2096
                https://orcid.org/0000-0002-9052-5569
                https://orcid.org/0000-0002-9103-3945
                https://orcid.org/0000-0002-7022-0194
                https://orcid.org/0000-0002-0100-229X
                https://orcid.org/0000-0002-3782-659X
                https://orcid.org/0000-0001-9067-599X
                Article
                00823-2020
                10.1183/23120541.00823-2020
                7983253
                33778056
                543dca98-a60f-428d-a1ef-5b8f7e2345ae
                Copyright ©The authors 2021

                This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

                History
                : 4 November 2020
                : 21 January 2021
                Categories
                Original Research Letters
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