title: Responsiveness and minimal clinically important change of the Pain Disability Index in patients with chronic back pain.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the Pain Disability Index (PDI) in patients with chronic back pain (CBP).
  
  
  BACKGROUND
  Treatment of patients with CBP is primarily focused on reduction of disability. For disability measurement, the PDI is a widely used questionnaire. There are, however, no data available on responsiveness and MCIC.
  
  
  METHODS
  Two hundred forty-two patients with CBP were included in this study. Patients filled in the PDI at baseline and at discharge. The PDI consists of 2 subscales: 1 measuring voluntary activities and 1 measuring obligatory activities. PDI was anchored at 2 self-reported global perceived effect (GPE) scales for complaints and self-care, respectively. Responsiveness was considered sufficient when Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) was higher than 0.70. To test interpretability, change scores and MCIC were calculated. MCIC was tested by determination of optimal cut-off point of the ROC curve and determination of specificity and sensitivity of the optimal cut-off point.
  
  
  RESULTS
  AUCs were 0.76 and 0.77 depending on the external criterion. The subscale obligatory activities did not meet the criteria for responsiveness (AUC: 0.63-0.69). MCIC of the PDI was 9.5 points for GPE "complaints" and 8.5 for GPE "self-care."
  
  
  CONCLUSIONS
  The total score of the PDI as well as the subscale of voluntary activities is responsive. Partly because of floor effects, the subscale obligatory activities are not sufficiently responsive in patients with CBP. However, the responsiveness of this subscale in other patient groups should be further tested. In patients with CBP, change can be considered clinically important when PDI score has decreased 8.5 to 9.5 points.
authors.affiliation: Groningen Spine Center, University Medical Center Groningen, University of Groningen, The Netherlands. r.soer@cvr.umcg.nl
authors.forename: Remko
authors.initials: R
authors.lastname: Soer
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Reneman
authors.forename: Patrick C A J
authors.initials: PC
authors.lastname: Vroomen
authors.forename: Patrick
authors.initials: P
authors.lastname: Stegeman
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Coppes
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000175:diagnosis* / Q000628:therapy; D059350:Chronic Pain / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome