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Estimating the minimum important change in the 15D scores
Abstract
Purpose To facilitate the interpretation of empirical results produced by the 15D, a generic, preference-based instrument for measuring health-related quality of life (HRQoL), a subjective five-category global assessment scale (GAS) was used as an external anchor to determine the minimum important change (MIC) in the 15D scores.Methods Altogether 4,903 hospital patients representing sixteen disease entities and having the 15D score at baseline repeated the HRQoL assessment at 6 months after treatment and answered the question: compared to the situation before treatment, my overall health status is now (1) much better, (2) slightly better, (3) much the same, (4) slightly worse, (5) much worse. Regression analysis was used to estimate the MIC for improvement/deterioration, defined as the lower/upper limit of 99.9 % confidence interval of the regression coefficient, standardized for baseline HRQoL, for categories (2) and (4), respectively, and confirmed by ROC curve analysis.Results The limits or intervals for classifying the changes of 15D scores into GAS categories were >.035 for (1), .015-.035 for (2),>-.015 and<.015 for (3), -.035--.015 for (4) and <-.035 for (5). The lower/upper limits of ±.015 for categories (2) and (4) can be regarded as the generic MIC thresholds for improvement/deterioration, respectively.Conclusions The generic MICs for the change of 15D scores are ±.015. Follow-up studies using the 15D should report the mean change in the 15D score, its statistical significance, relationship to the MIC, and the distribution of the changes of the 15D scores into the five categories.
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“It has been suggested that the generic minimal important change is ±0.015 and a large change is ±0.035 [22].”
From Improved cardiorespiratory fitness after occupational rehabilitation in merged diagnostic groups (2018) · cites this paper as [22]
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“The clinical importance of this change is uncertain, but it is in the area of cut-off suggested as a minimum important change [30].”
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“a Based on the reported minimal important difference (MID) for the instrument [24]. https://doi.org/10.1371/journal.pone.0266101.t003 (r = 0.46; 95% CI 0.36–0.55), but it did not differ statistically significantly from the other treat-ment groups (Fig 2A).”
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Self-citationVuontisjärvi, S., Rossi, H., Nordström, T., Karjula, S., Terho, A., Morin-Papunen, L. C., Koivurova, S., & Piltonen, T. (2025) · Human Reproduction · doi:10.1093/humrep/deaf154 · Cited by 4
“A change of 0.035 in the total score can be considered a large improvement or a deterioration in HRQoL (Alanne et al. , 2015).”
InfluentialSoukkio, P. K., Suikkanen, S. A., Sintonen, H., Kukkonen-Harjula, K. T., Kautiainen, H., Kääriä, S. M., Hupli, M. T., Aartolahti, E. M., Pitkälä, K. H., & Sipilä, S. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03545-4 · Cited by 4
“We calculated the unadjusted total 15D scores and profile scores of the 15D dimensions [1, 38], which are mobility, vision, hearing, breathing, sleeping, eating, speech (communication), excretion, usual activities, mental function, discomfort and symptoms, depression, distress, vitality, and sexual…”
InfluentialSelf-citationThe four category systematic approach for selecting patients for face transplantation
Sipilä, M., Kiukas, E.-L., Lindford, A., Ylä-Kotola, T., Lauronen, J., Sintonen, H., & Lassus, P. (2021) · Journal of Plastic Surgery and Hand Surgery · doi:10.1080/2000656x.2021.1933995 · Cited by 4
“Moreover, if the aesthetic outcome is considered to be one parameter of success it would then be advisable to perform a full FT in a patient with a large portion of their face injured [19].”
BackgroundSelf-citationOulasvirta, E., Pohjola, A., Koroknay-Pál, P., Hafez, A., Roine, R. P., Sintonen, H., & Laakso, A. (2022) · Journal of Neurosurgery Pediatrics · doi:10.3171/2022.5.peds2284 · Cited by 4
Self-citationFlinkkilä, T. E., Vähäkuopus, M., Sirniö, K., & Falkenbach, P. (2024) · Orthopaedics & Traumatology Surgery & Research · doi:10.1016/j.otsr.2024.103852 · Cited by 4
Quality of life and socioeconomic and educational status in patients with congenital hypothyroidism
Danner, E., Sund, R., Sintonen, H., Niuro, L., Niinikoski, H., Huopio, H., Viikari, L. A., & Jääskeläinen, J. (2024) · Pediatric Research · doi:10.1038/s41390-024-03170-y · Cited by 4
“A difference of ± 0.015 in the 15D score is clinically important 23 and is assumed to be similar for the 16D score.”
MethodInfluentialSelf-citationDoica, I. P., Turcu-Ştiolică, A., Ungureanu, B. S., Florescu, D. N., Rogoveanu, I., & Gheonea, D.-I. (2023) · PubMed Central · doi:10.12865/chsj.49.03.02 · Cited by 4
“An important clinical change in HRQoL was considered to be a minimum important difference of 0.015 in the 15D score from the basis [15], with the following five categories: "much better" (difference greater than 0.035), "slightly better" (difference between 0.015 and 0.035), "much the same (no…”
MethodInfluentialHanssen, T. A., Subbotina, A., Miroslawska, A., Solbu, M. D., & Steigen, T. K. (2022) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2022.2084562 · Cited by 4
Improved cardiorespiratory fitness after occupational rehabilitation in merged diagnostic groups
Nordstoga, A. L., Mork, P. J., & Steiro Fimland, M. (2018) · Annals of Occupational and Environmental Medicine · doi:10.1186/s40557-018-0227-y · Cited by 3
Santervas, L. R., Skovlund, E., Kristoffersen, E. S., Ringstad, I. B., Fjeld, K. G., Hove, L. H., Jensen, J. L., Tb, W., & Romskaug, R. (2026) · Age and Ageing · doi:10.1093/ageing/afag029 · Cited by 3
Mattsson, N. K., Karjalainen, P. K., Heikkinen, A. M., Nieminen, K., Jalkanen, J. T., & Tolppanen, A. (2020) · Neurourology and Urodynamics · doi:10.1002/nau.24467 · Cited by 3
“035).(15) Change in PFDI‐20 was categorized as “much better” (decrease > 45 points), “better” (decrease 23‐45 points), “no change” (decrease 22.”
Kissling, F. J., Goldberg, J., Raabe, A., & Bervini, D. (2024) · World Neurosurgery X · doi:10.1016/j.wnsx.2024.100305 · Cited by 3
“4,23 Hence, the post-coiling subgroup had a notably longer mean postoperative follow-up time compared to the post-clipping sub-group (1371 vs. 371 days), which presumably contributed to the higher mean QoL scores in the coiling cohort.”
ResultIrmola, T., Reito, A. R., Kangas, J., Eskelinen, A. P., Niemeläinen, M., Mattila, V. M., & Moilanen, T. P. S. (2025) · Acta Orthopaedica · doi:10.2340/17453674.2024.42708 · Cited by 3
Henson, G. J., van der Mei, I. A. F., Taylor, B. V., Scuffham, P., Chen, G., & Campbell, J. A. (2025) · The European Journal of Health Economics · doi:10.1007/s10198-025-01778-3 · Cited by 5
“Overall, 67 studies identified by our search strategy entered the review [14, 33 –98 ], The key characteristics of each included study are summarised in Supplementary Table 1, and the key characteristics of each MIC are summarised in Supplementary Table 2.”
Junttila, O. E., Pesonen, P., Timonen, M., & Auvinen, J. (2025) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2025.2492296 · Cited by 3
Heikkala, E., & Karppinen, J. I. (2025) · Family Practice · doi:10.1093/fampra/cmaf057 · Cited by 3
“Importantly, the observed mean differences in the 15D between the Psychiatric and Metabolic clusters, and the Relatively healthy cluster exceeded not only the minimal important difference level of 0.015 but also the level of a markedly changed status (0.035) [25].”
InfluentialImpact of a diabetes screening program on a rural Chinese population: a 3-year follow-up study
Zhang, Y., Ning, F., Sun, J., Pang, Z., Wang, X., Kapur, A., Sintonen, H., & Qiao, Q. (2015) · BMC Public Health · doi:10.1186/s12889-015-1570-3 · Cited by 3
“015 [13].”
Self-citationSahrakorpi, N., Engberg, E., Stach‐Lempinen, B., Tammelin, T., Kulmala, J., Roine, R. P., & Koivusalo, S. B. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01664-7 · Cited by 6
“015, representing the smallest difference that patients perceive as beneficial or harmful [27].”
BackgroundSelf-citationMętel, S., Kostrzon, M., Adamiak, J., Gattner, H., Sintonen, H., & Horst, R. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101609 · Cited by 3
Self-citationComprehensive outcome analysis in two composite face transplants in Helsinki: Have we succeeded?
Kiukas, E.-L., Sipilä, M., Manninen, A. A., Ylä-Kotola, T. M., Lindford, A. J., & Lassus, P. (2023) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2023.02.023 · Cited by 3
Multidisciplinary behavioral therapy reduces rumination
Nyyssönen, M., Vilpponen, O., Ståhl‐Railila, M., Liesto, S., Mustonen, T., Pikkarainen, S., Arkkila, P. E. T., Roine, R., Sintonen, H., & Punkkinen, J. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14919 · Cited by 3
“28 Our patients had other conditions besides rumination requiring further therapies, which were occurring at the 6-month control.”
Self-citationPynnä, K., Vuorela, P., Aronen, P., Sintonen, H., Vainiola, T., Leminen, A., Roine, R. P., & Räsänen, P. (2019) · Journal of Comparative Effectiveness Research · doi:10.2217/cer-2018-0125 · Cited by 3
Self-citationOjala, A. K., Sintonen, H., Roine, R. P., Strandberg, T. E., & Schalin‐Jäntti, C. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01537-9 · Cited by 3
Self-citationKanninen, J., Kautiainen, H., & Holm, A. (2024) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2024.2423233 · Cited by 2
Aapola, U., Mosallaei, P., Nättinen, J. E., Suurkuukka, I., Tuomilehto, J. O., Keinanen-Kiukaanniemi, S. M., Saramies, J., & Uusitalo, H. M. T. (2025) · Quality of Life Research · doi:10.1007/s11136-025-03907-0 · Cited by 2
“The generic minimum important change for the 15D score is ± 0.015, suggesting that the differences in the 15D score observed between DED and non-DED participants in our study can be clinically important [46 ].”
InfluentialKimpimäki, T., Karhu, M., Vaalasti, A., Karppinen, T. T., Sintonen, H., Huhtala, H., Salmi, T. T., & Ahti, T. M. (2025) · Journal of Wound Care · doi:10.12968/jowc.2022.0068 · Cited by 2
Self-citationLiira, H., Varonen, M., Venäläinen, M. S., Arokoski, J. P., Kvarnström, K., Vuokko, A., & Malmivaara, A. O. V. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112374 · Cited by 2
Cost-Effectiveness of Surgery Versus Functional Bracing for Humeral Shaft Fractures in Adults
Suter, C., Ibounig, T., Reito, A. R., Mattila, H., Sumrein, B. O., Launonen, A. P., Paavola, M. P., Järvinen, T. L. N., TAIMELA, S. P., Rämö, L., et al. (2026) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.25.00867 · Cited by 2
“The 15D ranges from 0 (death) to 1 ( health) and has a minimal important difference of 25,26 . the sharp decline in quality of life immediately after the injury and the high variability during the early recovery phase, the fi rst 6 weeks after the injury were excluded from the analysis.”
Peltola, E., Hannula, P. M., Huhtala, H., Sintonen, H., Metso, S., Sand, J. A., Laukkarinen, J., Tiikkainen, M., Schalin‐Jäntti, C., Sirén, J., et al. (2020) · Clinical Endocrinology · doi:10.1111/cen.14336 · Cited by 2
Self-citationRissanen, A. M., Roine, R. P., MARTTUNEN, M. J., Sintonen, H., & Lindberg, N. (2023) · Scandinavian Journal of Child and Adolescent Psychiatry and Psychology · doi:10.2478/sjcapp-2023-0004 · Cited by 2
Self-citationSantervas, L. R., Wyller, T. B., Skovlund, E., Jensen, J. L., Fjeld, K. G., Hove, L. H., Ringstad, I. B., Nordberg, L. B., Mellingen, K. M., Kristoffersen, E. S., et al. (2024) · Trials · doi:10.1186/s13063-024-08442-w · Cited by 2
“A change of ± 0.015 or more is considered the minimum important change (MIC), and a change of more than 0.035 in the positive direction represents “much better HRQoL” [34].”
BackgroundInfluentialGeneric Health‐Related Quality of Life of Children With Severe Peanut or Tree Nut Allergy
Saarimäki, L., Kivistö, J. E., Ojaniemi, I., Sintonen, H., Huhtala, H., Protudjer, J. L. P., Ekström, S., Kull, I., & Karjalainen, J. (2025) · Acta Paediatrica · doi:10.1111/apa.70016 · Cited by 2
Self-citationKettula, K., Tynkkynen, L., Sintonen, H., Tuisku, K., & Puustinen, N. (2019) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 2
Self-citationQuality of Life After Lung Cancer Surgery
Tsitsias, T., & Athanasiou, T. (2023) · Springer eBooks · doi:10.1007/978-3-031-27597-5_13 · Cited by 1
Metadata
- Authors
- Alanne, S., Roine, R. P., Räsänen, P., Vainiola, T., & Sintonen, H.
- Affiliations
- Seinäjoen Keskussairaala (FI)
- University of Eastern Finland (FI)
- Hospital District of Helsinki and Uusimaa (FI)
- University of Helsinki (FI)
- Corresponding author
- Sintonen, Harri
- Venue
- Quality of Life Research
- Published
- 2014-08-22
- Volume
- 24
- Issue
- 3
- Pages
- 599-606
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- OpenAlex
- W2023078845
- Cited by
- 231
- References
- 31
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 17 · 2023: 19 · 2022: 18 · 2021: 38 · 2020: 16 · 2019: 26 · 2018: 16 · 2017: 20 · 2016: 23 · 2015: 11 · 2014: 1
- FWCI
- 45.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Quality of Life Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- 15D, health-related quality of life, Global Assessment Scale, self-rated health, hospitalized patients
- MeSH terms
- Female, Finland, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Research Design, ROC Curve, Models, Statistical
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