Minimally clinically important difference in chronic breathlessness: Every little helps

Oxberry, Stephen G.; Bland, J. Martin; Clark, Andrew L.; Cleland, John G.F.; Johnson, Miriam J.

doi:10.1016/j.ahj.2012.05.003

Cited by 62Heart Failure Treatment and ManagementHealth Systems, Economic Evaluations, Quality of LifeChronic Obstructive Pulmonary Disease (COPD) Research

Minimally clinically important difference in chronic breathlessness: Every little helps

Oxberry, Stephen G., Bland, J. Martin, Clark, Andrew L., Cleland, John G.F., Johnson, Miriam J.·2012·American Heart Journal

DOI 10.1016/j.ahj.2012.05.003

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Abstract

Objectives The aim of the study was to determine the minimally clinically important difference (MCID) for breathlessness due to chronic heart failure (CHF).Background The measurement of breathlessness is difficult because it is subjective and multifactorial. Statistically significant changes in assessment may not be clinically meaningful. This is the first determination of MCID in chronic breathlessness in CHF using patient-rated data.Methods Measurements were made as part of a randomized, controlled, crossover trial of morphine, oxycodone, or placebo for breathlessness in CHF. Breathlessness intensity was assessed at baseline and at the end of each intervention (day 4) using 11-point numerical rating scales (NRS), modified Borg (mBorg) scales, and global impression of change (GC) in breathlessness at day 4. From these data, the change in NRS or mBorg associated with a 1-point change in GC was calculated.Results Thirty-five patients completed all study interventions, resulting in 105 data sets. We defined MCID as a 1-point change in GC. Regression analysis found that the MCID, including 95% CIs, equaled change in average NRS breathlessness per 24 hours of 0.5 to 2.0 U (P < .001), change in worst NRS breathlessness per 24 hours of 0.4 to 2.9 (P < .001), change in average mBorg score of 0.2 to 2.0 (P < .001), and change in worst mBorg score as between 0.3 and 1.9 (P < .001). Corresponding effect size calculations lay within the 95% CIs for the regression analysis for each measure.Conclusions A 1-point change in NRS or mBorg score is a reasonable estimate of the MCID in average daily chronic breathlessness in CHF.

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ROC analysis suggested the MCID for D12 should be ≥2.5 (area=0.74).
“Although this left only n=22 observations (the rest were 'stable') this analysis suggested the MCID for D12 should be ≥2.5 (area=0.74).”
From A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma (2017) · cites this paper as [29]
Using distribution-based analyses, both D12 and HADS were identified as potential endpoints for a future trial, but only D12 showed a large improvement in the treatment group.
“Using distribution-based analyses using effect sizes [29] both D12 and HADS were identified as potential endpoints for a future trial, but only D12 showed a large improvement in the treatment group (Table 2).”
From A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma (2017) · cites this paper as [29]
Regression between these variables suggested an MCID for D12 of at least 2.0.
“We considered the regression between these variables [29] which suggested an MCID for D12 of at least 2.0.”
From A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma (2017) · cites this paper as [29]

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Authors: Oxberry, S. G., Bland, J. M., Clark, A. L., Cleland, J. G. F., & Johnson, M. J.
Affiliations: Kirkwood Hospice (GB)
University of Hull (GB)
Corresponding author: Johnson, Miriam J.
ORCID: Clark, Andrew L.
Cleland, John G.F.
Johnson, Miriam J.
Venue: American Heart Journal
Publisher: Elsevier BV
Published: 2012-08
Volume: 164
Issue: 2
Pages: 229-235
ISSN: 0002-8703 (ISSN-L)
DOI: 10.1016/j.ahj.2012.05.003
OpenAlex: W2147441553
Cited by: 62
References: 37
Citations by year: 2026: 3 · 2025: 5 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 7 · 2014: 3 · 2013: 5 · 2012: 2
FWCI: 3.50
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Heart Journal (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Repository@Hull (Worktribe) (University of Hull) (submittedVersion)
Funders: National Institute for Health and Care Research (NF-SI-0611-10227)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Keywords: minimal clinically important difference, chronic breathlessness, chronic heart failure, numerical rating scale, modified Borg scale, global impression of change, patient-reported outcomes, morphine, oxycodone, opioid analgesia
MeSH terms: Chronic Disease, Dyspnea, Heart Failure, Humans

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Minimally clinically important difference in chronic breathlessness: Every little helps

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