title: The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice.
abstract: OBJECTIVE
  To estimate the minimally important difference (MID) for a fatigue visual analog scale (VAS) using patient-reported anchors (fatigue, pain, and overall health).
  
  
  METHODS
  Patients with rheumatoid arthritis (RA; n = 307) had 2 clinic visits at a median of 5.9 months apart. They completed a fatigue VAS (0-10 scale) and the retrospective anchor items, "How would you describe your overall fatigue/pain/overall health since the last visit?" with response options: Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened.
  
  
  RESULTS
  The mean [standard deviation (SD)] age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) Health Assessment Questionnaire-Disability Index score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at followup was 4.3 (2.8) [mean change of -0.07 (2.5); p = not significant]. The fatigue change score (0-10 scale) for Somewhat better and Somewhat worsened for the fatigue anchor averaged -1.12 and 1.26, respectively. Using the pain anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.87 and 1.13; and using the global anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.82 and 1.17, respectively. Effect size estimates using 3 anchors were small for the Somewhat better (range 0.27-0.39) and Somewhat worsened (0.40-0.44) groups, but larger than for the no-change group (0.03-0.08).
  
  
  CONCLUSIONS
  The MID for fatigue VAS is between -0.82 for -1.12 for improvement and is 1.13 to 1.26 for worsening on a 0-10 scale in a large RA clinical practice, and is similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice.
authors.affiliation: Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA. dkhanna@mednet.ucla.edu
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.forename: Puja P
authors.initials: PP
authors.lastname: Khanna
authors.forename: Michelle
authors.initials: M
authors.lastname: Maloney
authors.forename: Nooshin
authors.initials: N
authors.lastname: Samedi
authors.forename: Debbie
authors.initials: D
authors.lastname: Norrie
authors.forename: Gillian
authors.initials: G
authors.lastname: Ouimet
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D005221:Fatigue / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012720:Severity of Illness Index