One-SEM changes corresponded well to patient-driven minimal clinically important difference standards on all Chronic Heart Failure Questionnaire dimensions (weighted kappa 0.87; P < 0.001).
Does the standard error of measurement (SEM) correspond to established standards for clinically relevant intra-individual change in health-related quality of life among outpatients with cardiac problems?
The standard error of measurement (SEM) corresponds well to established minimal clinically important differences and may serve as a proxy for clinically meaningful intra-individual change in health-related quality of life.
Effect estimate: weighted kappa 0.87
p-value: p=<0.001
OBJECTIVE: To compare the standard error of measurement (SEM) with established standards for clinically relevant intra-individual change in an evaluation of health-related quality of life. DESIGN: Secondary analysis of data from a randomized controlled trial. SUBJECTS: Six hundred and five outpatients with a history of cardiac problems attending the general medicine clinics of a major academic medical center. MEASURES: Baseline and follow-up interviews included a modified version of the Chronic Heart Failure Questionnaire (CHQ) and the SF-36. The SEM values corresponding to established standards for minimal clinically important differences (MCIDs) on the CHQ were determined. Individual change on the SF-36 was explored using the same SEM criterion. RESULTS: One-SEM changes in this population corresponded well to the patient-driven MCID standards on all CHQ dimensions (weighted kappas (0.87; P < 0.001). The distributions of outpatients who improved, remained stable, or declined (defined by the one-SEM criterion) were generally consistent between CHQ dimensions and SF-36 subscales. CONCLUSIONS: The use of the SEM to evaluate individual patient change should be explored among other health-related quality of life instruments with established standards for clinically relevant differences. Only then can it be determined whether the one-SEM criterion can be consistently applied as a proxy for clinically meaningful change.
Wyrwich et al. (1999) studied History of cardiac problems (n=605). Standard error of measurement (SEM) vs. Minimal clinically important differences (MCIDs) was evaluated on Correspondence between one-SEM changes and patient-driven MCID standards on CHQ dimensions (weighted kappa 0.87, p=<0.001). One-SEM changes corresponded well to patient-driven minimal clinically important difference standards on all Chronic Heart Failure Questionnaire dimensions (weighted kappa 0.87; P < 0.001).