Mathematical coupling may account for the association between baseline severity and minimally important difference values.
OBJECTIVE
To generate anchor-based values for the "minimally important difference" (MID) for a number of commonly used patient-reported outcome (PRO) measures and to examine whether these values could be applied across the continuum of preoperative patient severity.


METHODS
Six prospective cohort studies of patients undergoing elective surgery at hospitals in England and Wales. Patients completed questionnaires about their health and health-related quality of life before and after surgery. MID values were calculated using the mean change score for a reference group of patients who reported they were "a little better" after surgery minus the mean change score for those who said they were "about the same." Pearson's correlation was used to examine the association between baseline severity and change scores in the reference group. Baseline severity was expressed in two ways: first in terms of preoperative scores and second in terms of the average of pre- and postoperative scores (Oldham's method).


RESULTS
Of the 10 PRO measures examined, eight demonstrated a moderate or high positive association between preoperative scores and MID values. Only two measures demonstrated such an association when Oldham's measure of baseline severity was used.


CONCLUSIONS
In general, there is little association between baseline severity and MID values. However, a moderate association persists for some measures, and it is recommended that researchers continue to test for this relationship when generating anchor-based MID values from change scores.
Browne
John Patrick
JP
Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. john.browne@Lshtm.ac.uk
van der Meulen
Jan H
JH
Lewsey
James D
JD
Lamping
Donna L
DL
Black
Nick
N
D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D006302:Health Services Research; D059685:Herniorrhaphy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D015203:Reproducibility of Results; D012220:Rhinitis / Q000601:surgery; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014648:Varicose Veins / Q000601:surgery; D014852:Wales / Q000453:epidemiology