Abstract
BackgroundThe aims of the present study were first to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, non-steroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion.MethodsThe study involved 173 patients with osteoarthritis in whom primary care physicians decided to start treatment with non-selective NSAIDs. Assessments at admission and after 6 weeks were conducted. In order to determine the threshold levels associated with a definition of clinically important improvement, the receiver operating characteristic method was used. Three different measures of response to a 6-week NSAIDs treatment were used: one indirect measure (MCID in the total WOMAC score), one direct measure (transition question) and a combination of both criteria.ResultsEighty patients (46.3%) reported "a slightly better" general health status compared to that of 6 weeks before NSAIDs treatment. The MCID proportion is a 16.0% reduction in WOMAC. The most stable pre-treatment predictors on the improvement of health after treatment by NSAIDs were the absence of previous knee injury and a high level of education.ConclusionsIn our data, a 16.0% reduction of the total WOMAC score from baseline was associated with the highest degree of improvement on the transition scale category. This cut-off point had good accuracy, and should be appropriate for use in the interpretation of clinical studies results, as well as in clinical care.
Highlights
The aims of the present study were first to detect minimal clinically important difference (MCID) for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, nonsteroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion
The aims of the present study were first, to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, non-steroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion
The MCID proportion is a 16.0% reduction in WOMAC
Summary
The aims of the present study were first to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, nonsteroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion. A comprehensive assessment of the patient’s health status is gaining in importance, that health care is becoming increasingly evidence-based. The ability of an instrument to detect such a small difference is essential in order to quantify the minimal difference that patients and their physicians consider clinically important. The minimal clinically important difference (MCID) can be defined generally as the smallest difference in score that patients perceive as beneficial and which would mandate, in the absence of troublesome side effects and excessive costs, a change in the patient’s management [7]. For the assessment of interventions in OA of the lower extremities, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is generally recommended as the most sensitive, condition-specific instrument [9,10,11,12,13,14]
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