University of Groningen
Discovering the Dynamics of the Minimal Clinically Important Difference of Health Status
Instruments in Patients with Chronic Obstructive Pulmonary Disease
Mol-Alma, Harma
DOI:
10.33612/diss.136223443
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Document Version
Publisher's PDF, also known as Version of record
Publication date: 2020
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Mol-Alma, H. (2020). Discovering the Dynamics of the Minimal Clinically Important Difference of Health Status Instruments in Patients with Chronic Obstructive Pulmonary Disease. University of Groningen. https://doi.org/10.33612/diss.136223443
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Thesis propositions
1. The minimal clinically important difference (MCID) is a complex parameter that is often manipulated or misused in both scientific research and clinical practice (Chapter 1).
2. Using the 4-point MCID threshold for the St. George’s Respiratory Questionnaire could have led to an overestimation of treatment outcomes in multiple clinical trials for COPD (Chapter 3).
3. The MCIDs of the COPD Assessment Test and the Clinical COPD Questionnaire are underpinned by more valid and robust evidence than the St. George’s Respiratory Questionnaire, indicating that their thresholds should be used for evaluating therapy outcomes (Chapters 3 to 7).
4. MCIDs are only valid if multiple techniques are applied, with relevant anchors determined in multiple populations and study types (Chapters 4 to 7).
5. Interventional studies and routine clinical practice require different MCID thresholds to interpret the observed changes (Chapters 6 and 7).
6. Concerning health status in patients with COPD, the MCIDs for improvement are similar to those for clinically relevant deterioration (Chapters 6 and 7).
7. Separate MCID thresholds should be applied depending on the baseline health status severity of a patient (Chapter 7).
8. Clinical practice and scientific research will benefit from applying a dynamic MCID framework for interpreting (individualised) therapy outcomes in COPD (Chapter 8).
9. Clinicians must continuously interpret clinically relevant changes in various
parameters for both daily clinical practice and treatment guidelines, yet few clinicians have a complete understanding of the dynamics of the MCID.
10. “It is not the mountain we conquer, but ourselves” (Sir Edmund Hillary). 11. Succes is het resultaat van willen en doen.
