title: Percutaneous stereotactic radiofrequency lesioning for trigeminal neuralgia: determination of minimum clinically important difference in pain improvement for patient-reported outcomes.
abstract: BACKGROUND
  The Visual Analog Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNI-PS) are 2 patient-reported outcome (PRO) tools frequently used to rate pain from trigeminal neuralgia (TN). Outcomes studies often use these patient-reported outcomes to assess treatment effectiveness, but it is unknown exactly what degree of change in the numerical scores constitutes the minimum clinically important difference (MCID). MCID remains uninvestigated for percutaneous stereotactic radiofrequency lesioning (RFL), a common surgical procedure for TN.
  
  
  OBJECTIVE
  To determine MCID values for the VAS and BNI-PS in patients undergoing RFL.
  
  
  METHODS
  Forty-three consecutive patients with TN who underwent RFL by a single surgeon were prospectively assessed with the VAS and BNI-PS preoperatively and 3 years postoperatively. Three anchors were used to assign each patient's outcome: satisfaction, willingness to have the surgery again, and Health Transition Index. We then used 3 well-established, anchor-based methods to calculate MCID: average change, minimum detectable change, and change difference.
  
  
  RESULTS
  Patients experienced substantial improvement in both VAS (9.81 vs 3.35; P < .001) and BNI-PS (4.95 vs 2.44; P < .001) after RFL. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS, 4.13-8.20; BNI-PS, 1.03-3.30). The area under the receiver-operating characteristic curve was greater for BNI-PS compared with VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID.
  
  
  CONCLUSIONS
  RFL-specific MCID is variable on the basis of the calculation technique. With the use of the minimum detectable change calculation method with the Health Transition Index anchor, the minimum clinically important difference is 4.49 for VAS and 1.16 for BNI-PS after RFL for TN.
  
  
  BACKGROUND
  AUC, area under the receiver-operating characteristic curveBNI-PS, Barrow Neurological Institute Pain ScaleHTI, Health Transition IndexMCID, minimum clinically important differenceMDC, minimum detectable changePRO, patient-reported outcomeRFL, percutaneous stereotactic radiofrequency lesioningTN, trigeminal neuralgiaVAS, Visual Analog Scale.
authors: *Vanderbilt University Medical Center, Nashville, Tennessee; ‡Vanderbilt University Center for Quantitative Sciences, Nashville, Tennessee; §Department of Statistics, National Cheng Kung University, Tainan, Taiwan; ¶HW Neurological Institute, Nashville, Tennessee.
authors: Vishruth K
authors: VK
authors: Reddy
authors: Scott L
authors: SL
authors: Parker
authors: Dennis T
authors: DT
authors: Lockney
authors: Samit A
authors: SA
authors: Patrawala
authors: Pei-Fang
authors: PF
authors: Su
authors: Robert A
authors: RA
authors: Mericle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D012372:ROC Curve; D016634:Radiosurgery / Q000379:methods*; D014277:Trigeminal Neuralgia / Q000523:psychology / Q000601:surgery*