The minimal clinically important difference in allergic rhinitis

M. L. Barnes, S. Vaidyanathan, P. A. Williamson, B. J. Lipworth

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    Abstract

    Background

    When presented with results from clinical measurements or research findings, clinicians must first make an interpretation of their importance, not only in statistical terms, but also the 'clinical importance' given the size of the change observed. To do this, they require an understanding of the relationship between their outcome measures, and the patient's perception of change. The minimal clinically important difference (MCID) illustrates this relationship by calculating the smallest change in a given outcome that is meaningful to a patient. There are few reports of calculated MCIDs in the Rhinology literature.

    Objective

    To calculate MCIDs for common subjective and objective outcome measures in allergic rhinitis (AR).

    Methods

    Nine randomized, blinded, placebo-controlled clinical trials in intermittent and persistent AR (pooled subjects, n=204) were analysed using anchor- and distribution-based approaches, applying regression and meta-analysis techniques.

    Results

    MCIDs were obtained for the Mini Rhinoconjunctivitis Quality of Life Questionnaire: 0.4 units, peak nasal inspiratory flow: 5 L/min and total nasal symptoms score: 0.55 units. Nasal NO measurement changes had no correlation with patient perceptions of benefit.

    Conclusion

    Estimates of MCIDs were obtained for common subjective and objective rhinological outcomes. MCIDs can and should be applied by physicians interpreting research findings, as well as researchers reporting their findings. We can then be confident that our changes in practice will be of perceptible benefit to the patient.

    Cite this as: M. L. Barnes, S. Vaidyanathan, P. A. Williamson and B. J. Lipworth, Clinical & Experimental Allergy, 2010 (40) 242-250.

    Original languageEnglish
    Pages (from-to)242-250
    Number of pages9
    JournalClinical and Experimental Allergy
    Volume40
    Issue number2
    DOIs
    Publication statusPublished - Feb 2010

    Keywords

    • Allergic rhinitis
    • Mini Rhinoconjunctivitis Quality of Life Questionnaire
    • Minimal clinically important difference
    • Peak nasal inspiratory flow rate
    • Total nasal symptom score
    • Quality of life
    • Adenosine monophosphate challenge
    • Combined mediator blockade
    • Aqueous nasal spray
    • Nitric oxide
    • Controlled trial
    • 2008 update
    • Asthma
    • Airway
    • Questionnaire

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