Minimal clinically important differences for the EQ-5D and QWB-SA in Post-traumatic Stress Disorder (PTSD): results from a Doubly Randomized Preference Trial (DRPT)

Health and Quality of Life Outcomes (Impact Factor: 2.1). 04/2013; 11(1):59. DOI: 10.1186/1477-7525-11-59
Source: PubMed

ABSTRACT OBJECTIVE: To determine the minimal clinically important difference (MCID) for the health-utility measures EuroQol-5 dimensions (EQ-5D) and Quality of Well Being Self-Administered (QWB-SA) Scale in PTSD patients.Research design and methods: Two hundred patients aged 18 to 65 years with PTSD enrolled in a doubly randomized preference trial (DRPT) examining the treatment and treatment-preference effects between cognitive behavioral therapy and pharmacotherapy with sertraline and completed the EQ-5D and QWB-SA at baseline and 10-week post-treatment. The anchor-based methods utilized a Clinical Global Impression-Improvement (CGI-I) and Clinical Global Impression-Severity. We regressed the changes in EQ-5D and QWB-SA scores on changes in the anchors using ordinary least squares regression. The slopes (beta coefficients) were the rates of change in the anchors as functions of change in EQ-5D and QWB, which represent our estimates of MCID. In addition, we performed receiver operating characteristic (ROC) curve analysis to examine the relationship between the changes in EQ-5D and QWB-SA scores and treatment-response status. The MCIDs were estimated from the ROC curve where they best discriminate between treatment responders and non-responders. The distribution-based methods used small to moderate effect size in terms of 0.2 and 0.5 of standard deviation of the pre-treatment EQ-5D and QWB-SA scores.Clinical trial registration:; Identifier: NCT00127673. RESULTS: The anchor-based methods estimated the MCID ranges of 0.05 to 0.08 for the EQ-5D and 0.03 to 0.05 for the QWB. The MCID ranges were higher with the distribution-based methods, ranging from 0.04 to 0.10 for the EQ-5D and 0.02 to 0.05 for the QWB-SA. CONCLUSIONS: The established MCID ranges of EQ-5D and QWB-SA can be a useful tool in assessing meaningful changes in patient's quality of life for researchers and clinicians, and assisting health-policy makers to make informing decision in mental health treatment.

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    ABSTRACT: Limited data define what constitutes a minimal clinically important difference (MCID) on the EuroQol 5-Dimension (EQ-5D) health status index in persons with multiple sclerosis (PwMS). We sought to estimate the MCID for the EQ-5D health index in North American PwMS.
    Health and Quality of Life Outcomes 05/2014; 12(1):66. DOI:10.1186/1477-7525-12-66 · 2.10 Impact Factor
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    ABSTRACT: BackgroundThe size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders.MethodsThe research was conducted as an expert survey and expert panel discussion during a scientific workshop.ResultsEighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required.ConclusionInnovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.
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    ABSTRACT: Objective: To study functional status (FS) and quality of life (QoL) after discharge from intensive care unit (ICU) in patients who had > 24 hours of mechanical ventilation (MV) and to compare them with reference Argentine population. Design: Prospective cohort study. Setting: ICU at Sanatorio Anchorena, Buenos Aires, Argentina. Patients: All patients admitted to the ICU between September 2008 and April 2009 with more than 24 hours of MV. Procedures: QoL was assessed by EQ-5D and FS was evaluated through Barthel index [evaluation of daily life activities (DLA)] by telephone at 4 months and 1 year after discharge from ICU. Results: 77 patients required MV, 41 females (53%), median age 65 years (IQR 55-77), SAPSII 41 (28-52), days of MV 4 (2-8). 47 patients survived after hospitalization, 40 (85.1%) at 4 months and 34 (72.3%) one year later. The EQ-5D at 4 months (median 0.693 IQR0.182-0.982) and at 1 year (median 0.841 IQR0.493-1) of follow up were significantly lower compared with general Argentine population (p = 0.0004 and 0.024 respectively). At 4 months, half of the patients had problems in all dimensions of the Euroqol and 57% were dependent on DLA. At 1 year, 54% could not return to their previous activities, suffered from anxiety/depression and 45% were dependent on DLA. Conclusions: Effects of critical illness and ICU stay are present at 4 months and 1 year after discharge. Survivors suffer a lower quality of life and functional status than general population.

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