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Table 1 Studies determining minimal clinically important difference as a mean changea (35 studies, 7894 patients)

From: Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain

Study

n

Patient characteristics

Methodological characteristics

MCID

  

Clinical condition

Age, years (range)b

Male sex, %

Baseline pain, mm

Pain scale

Transition scale (directionality, categories)

Follow-up (Analysis adjusted)c

Category defining MCID

Absoluted mm (95% CI)

Relativee % (95% CI)

Aicher [25]

1743

Headache

38h (16–72)

24

64

VAS

1-sided, 4 cat

Single

Less good efficacy

27 (25–29)

NR

Bailey [26]

202

Mixedg

12 (8–17)

57

NR

NRS

2-sided, 5 cat

Single

A little better

10 (0–20)h

NR

Barton 2002 (reported in Jensen 2002 [43])

125

Post-operation pain (laparotomy)

41

0

NR

VAS

1-sided, 5 cat

Multiple (unclear)

A little relief

9 (7–12)

13 (8–17)

Bernstein [27]

135

Unspecified

42 (21–65)

45

100h

NRS

1-sided, 5 cat

Single

A little relief

21 (18–24)

NR

Bijur [28]f

108

Unspecified

44 (21–85)

40

73

VAS + NRS

2-sided, 5 cat

Multiple (no)

A little less pain

16 (11–21)

22 (15–28)

Bijur [29]f

195

Unspecified

74

27

74

NRS

2-sided, 5 cat

Multiple (yes)

A little less pain

15 (14–17)

24 (21–27)

Bijur [30]f

214

Unspecified

74

34

86

NRS

2-sided, 5 cat

Multiple (yes)

A little less pain

14 (12–15)

22 (19–25)

Bird [31]

77

Isolated extremity trauma

38

62

52

VAS

2-sided, 5 cat

Multiple (no)

A little less pain

20 (15–25)

NR

Bulloch [32]

121

Mixedg (65% traumatic, 35% non-traumatic)

10 (5–16)

56

60h

VAS

2-sided, 5 cat

Multiple (no)

A little less pain

17 (11–23)

NR

Cepeda [33]

700

Post-operation pain (mixed)

41 (16–88)

38

79

NRS

1-sided, 5 cat

Multiple (yes)

Minimal improvement

17 (10–20)h

20 (13–30)h

Chow [34]

105

Pain flare after radiotherapy

70h

56

50

NRS

2-sided, 3 cat

Multiple (no)

Better

23 (20–26)

NR

Degerli [35]

306

Thoraco-abdominal pain (non-traumatic)

42 (17–83)

40

67

VAS

2-sided, 5 cat

Multiple (no)

A little less pain

25 (23–26)

NR

Farrar [36]

134

Cancer-related breakthrough pain

55 (21–87)

53

NR

NRS

1-sided, 5 cat

Multiple (yes)

Slight relief

13–19j

16–34j

Fosnocht [37]

1490

Mixedg

36 (18–89)

47

63

VAS

2-sided, 5 cat

Multiple (no)

A little less pain

21 (19–23)

NR

Gallagher [38]f

96

Mixedg

37 (19–71)

45

64

VAS

2-sided, 5 cat

Multiple (yes)

A little less pain

15 (11–18)

17 (6–29)

Gallagher [39]f

101

Abdominal pain

40 (15–88)

39

65

VAS

2-sided, 5 cat

Multiple (yes)

A little less pain

18 (14–21)

23 (12–33)

Grilo [40]

50

Rheumatic conditions

49 (16–85)

44

78

VAS

1-sided, 5 cat

Single

Moderate relief

40i

NR

Grotle [41]

54

Acute low back pain

38

27

39

VAS + NRS

2-sided, 6 cat

Single

Slightly improved

34 (20–48)

 

Holdgate [42]f

79

Unspecified

53 (21–93)

NR

54

VAS + NRS

2-sided, 5 cat

Multiple (yes)

A bit better

16 (12–20)

34 (27–41)

Kelly [44]

Kelly [45, 46]

156

Mixedg (43% traumatic, 57% non-traumatic)

44 (16–97)

56

51

VAS

2-sided, 5 cat

Multiple (unclear)

A little better

8 (4–12)

NR

Kendrick 2005 [47]

356

Mixedg (35% traumatic, 65% non-traumatic)

41h

42

66

NRS

2-sided, 5 cat

Multiple (no)

A little less pain

15 (13–16)

NR

Lopez [21]

74

Sickle cell crisis

NR

NR

79

VAS

2-sided, 5 cat

Multiple (no)

A little better

14 (11–16)h,k

NR

Mark [48]

186

Unspecified

49 (15–87)

38

65

VAS

2-sided, 5 cat

Single

A little better

17 (14–20)k

NR

Martin [49]

95

Third molar extraction

30

40

33

VAS

2-sided, 7 cat

Single

Much improved or best ever

23i

72i

Martin [49]

63

Third molar extraction

25

40

35

Do

Do

Do

Do

25i

69i

Martin [49]

62

Third molar extraction

27

50

30

Do

Do

Do

Do

29i

85i

McConahay [50]

126

Mixedg (48% traumatic, 52% non-traumatic)

9 (5–12)

56

83

VAS

2-sided, 5 cat

Single

A little less pain

24 (17–31)

NR

Mohan [51]f

125

Unspecified

35h

44

46

VAS + NRS

2-sided, 5 cat

Multiple (yes)

A bit better

13 (9–17)

18 (1–35)

Myrvik [52]

28

Sickle cell crisis

15 (8–18)

50

75h

VAS + NRS

2-sided, 5 cat

Multiple (unclear)

A little better

10 (4–15)

NR

Powell [53]

73

Mixed (63% traumatic, 37% non-traumatic)

12 (8–15)

NR

60

VAS

2-sided, 5 cat

Multiple (yes)

A bit better

11i

NR

Rasmussen 2002 (reported in Jensen 2002 [43])

123

Post-operation pain (knee surgery)

65

34

NR

VAS

1-sided, 5 cat

Multiple (unclear)

A little relief

13 (10–17)

18 (14–22)

Sloman [54]

150

Post-operation pain (mixed)

47 (14–89)

53

67

NRS

1-sided, 5 cat

Single

Minimal relief

18i

36 (21–51)

Stahmer [55]

81

Mixedg (31% traumatic, 69% non-traumatic)

38 (16–87)

44

68

NRS

1-sided, 5 cat

Single

Some relief or partial relief

NR

30 (18–42)

Todd [56]

48

Trauma

35h (17–76)

69

56

VAS

2-sided, 5 cat

Multiple (no)

A little less pain

16 (10–22)

NR

Voepel-Lewis [59]

113

Post-operation pain (e.g. spinal fusion, splenectomy)

13 (7–16)

43

NR

NRS

2-sided, 5 cat

Multiple (yes)

A little better

10 (5–15)

NR

  1. aMean change in pain score among patients with minimum improvement of pain
  2. bMean (range) if not otherwise indicated,
  3. cEstimate based on single or multiple follow-up measurements (were standard errors adjusted for dependency between multiple measurements?)
  4. dAbsolute = mm reduction on a 100 mm scale
  5. eRelative = % reduction from baseline
  6. fIndividual patient data provided by authors
  7. gMixed patient population recruited at Hospital Emergency Department
  8. hData is median (inter-quartile range)
  9. i95% CI unavailable
  10. jEstimates for subgroups with different baseline pain
  11. kPatients with minimal improvement and worsening of pain were combined
  12. MCID minimum clinically important difference, VAS visual analogue scale, NRS numeric rating scale, CI confidence interval, NR not reported