A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain

Manuela L. Ferreira*, Robert D. Herbert, Paulo H. Ferreira, Jane Latimer, Raymond W. Ostelo, Dafne P. Nascimento, Rob J. Smeets

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To critically and systematically review methods used to estimate the smallest worthwhile effect of interventions for nonspecific low back pain. Study Design and Setting: A computerized search was conducted of MEDLINE, CINAHL, LILACS, and EMBASE up to May 2011. Studies were included if they were primary reports intended to measure the smallest worthwhile effect of a health intervention (although they did not need to use this terminology) for nonspecific low back pain. Results: The search located 31 studies, which provided a total of 129 estimates of the smallest worthwhile effect. The estimates were given a variety of names, including the Minimum Clinically Important Difference, Minimum Important Difference, Minimum Worthwhile Reductions, and Minimum Important Change. Most estimates were obtained using anchor- or distribution-based methods. These methods are not (or not directly) based on patients' perceptions, are not intervention-specific, and are not formulated in terms of differences in outcomes with and without intervention. Conclusion: The methods used to estimate the smallest worthwhile effect of interventions for low back pain have important limitations. We recommend that the benefit harm trade-off method be used to estimate the smallest worthwhile effects of intervention because it overcomes these limitations.
Original languageEnglish
Pages (from-to)253-261
JournalJournal of Clinical Epidemiology
Volume65
Issue number3
DOIs
Publication statusPublished - Mar 2012

Keywords

  • Minimum clinically important difference
  • Sufficiently important difference
  • Low back pain
  • Clinical trials
  • Research design
  • Literature review

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