Microvascular Decompression for Classic Trigeminal Neuralgia: Determination of Minimum Clinically Important Difference in Pain Improvement for Patient Reported Outcomes
Microvascular Decompression for Classic Trigeminal Neuralgia: Determination of Minimum Clinically Important Difference in Pain Improvement for Patient Reported Outcomes
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DOI：
10.1227/neu.0b013e318286fad2
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发表时间：
2013-05-01
期刊：
影响因子：
4.8
通讯作者：
Mericle, Robert A.
中科院分区：
文献类型：
--
作者：
Reddy, Vishruth K.;Parker, Scott L.;Mericle, Robert A.
背景：结果研究使用患者报告的结果（PRO）测量来评估治疗效果，但可能缺乏直接的临床意义。最小临床重要差异 (MCID) 计算提供了实现临床相关治疗效果所需的关键阈值的点估计。 MCID 尚未针对微血管减压 (MVD) 进行研究，微血管减压 (MVD) 是治疗三叉神经痛的常见外科手术。 目的：我们旨在确定 MVD 后最常用的 PRO 疼痛测量的 MCID：视觉模拟量表 (VAS) 和巴罗神经研究所疼痛量表 (BNI-PS)。 方法：对 60 名决定由一位外科医生接受 MVD 的连续 60 名经典三叉神经痛患者进行前瞻性评估，并使用 VAS 和术前和术后 2 年的 BNI-PS。使用三个锚点来分配每个患者的结果。然后，我们使用 3 种完善的基于锚的方法来计算 MCID。 结果：MVD 后，患者的 VAS（9.9 vs 2.0，P < .001）和 BNI-PS（5.0 vs 1.9，P < .001）均出现显着改善。对于所有 3 个锚点，BNI-PS 的接收者操作特征曲线下面积均大于 VAS，这表明 BNI-PS 可能更适合计算 MCID。 3 种 MCID 计算方法为每个 PRO 生成了一系列 MCID 值（VAS：1.40-8.87，BNI-PS：0.95-3.26）。结论：MVD 特定的 MCID 根据计算技术的不同而变化很大。其中一些计算似乎高估或低估了患者的术前期望。当对不同的 MCID 方法进行平均时，结果在临床上是合适的并且与术前预期一致。 VAS 的平均 MCID 为 6.25，BNI-PS 的平均 MCID 为 2.44。
BACKGROUND: Outcomes studies use patient-reported outcome (PRO) measurements to assess treatment effectiveness, but can lack direct clinical meaning. Minimum clinically important difference (MCID) calculation provides a point estimate of the critical threshold needed to achieve clinically relevant treatment effectiveness. MCID remains uninvestigated for microvascular decompression (MVD), a common surgical procedure for trigeminal neuralgia.OBJECTIVE: We aimed to determine MCID for the most commonly used PRO measures of pain after MVD: Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Scale (BNI-PS).METHODS: Sixty consecutive patients with classic trigeminal neuralgia who decided to undergo MVD by a single surgeon were prospectively assessed with VAS and BNI-PS preoperatively and 2 years postoperatively. Three anchors were used to assign each patient's outcome. We then used 3 well-established, anchor-based methods to calculate MCID.RESULTS: Patients experienced significant improvement in both VAS (9.9 vs 2.0, P < .001) and BNI-PS (5.0 vs 1.9, P < .001) after MVD. The area under the receiver-operating characteristic curve was greater for BNI-PS than for VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS: 1.40-8.87, BNI-PS: 0.95-3.26).CONCLUSION: MVD-specific MCID is highly variable based on calculation technique. Some of these calculations appear to either overestimate or underestimate the patients' preoperative expectations. When the different MCID methods are averaged, the results are clinically appropriate and consistent with preoperative expectations. The average MCID for VAS is 6.25 and for BNI-PS is 2.44.