Meaningful Change for PROMIS®

Estimates for the magnitude of change that corresponds to “important” change are published.

         Finally, you should keep in mind that most MID estimates are an average across the range of scores. It may be that people require more or less change to consider it meaningful depending on where they started. [KFC1] 


 [KFC1]Kozlowski AJ, Cella D, Nitsch KP, Heinemann AW. Evaluating Individual Change

With the Quality of Life in Neurological Disorders (Neuro-QoL) Short Forms. Arch

Phys Med Rehabil. 2016 Apr;97(4):650-4.e8. doi: 10.1016/j.apmr.2015.12.010.

PubMed PMID: 26740062; PubMed Central PMCID: PMC4994512.

 

Watch this 3-minute video about meaningful change in PROMIS scores.

 
Many terms for change (e.g., clinically important change, minimally important change, minimally perceptible change) are used. Specific estimates for minimally important differences (MIDs) are below. We report which administrations of a measure (e.g., 7-item form, CAT) were used to derive the MID estimates. This does not imply that there are different estimates for different forms.

 

PROMIS ADULT MID ESTIMATES

Many terms for change (e.g., clinically important change, minimally important change, minimally perceptible change) are used. Specific estimates for minimally important differences (MIDs) are below. We report which administrations of a measure (e.g., 7-item form, CAT) were used to derive the MID estimates. This does not imply that there are different estimates for different forms.

Anxiety
  • Change of 4 points (used 4-, 6- and 8-item short forms with chronic musculoskeletal pain and comorbid depression and/or anxiety sample) Kroenke
  • Change of 2.3-3.4 points (used short form with knee OA sample) Lee
  • Change of 3.0-5.5 points (used CAT with chronic pain sample) Swanholm
  • Change of 3.0-4.5 points (used 9 item short form with cancer sample)  Yost
Depression
  • Change of 3-4 points (used short forms 4a, 6a, 8a, 8b short forms with chronic low back pain, hip/knee osteoarthritis pain, and stroke samples) Kroenke
  • Change of 3.0-3.1 points (used short form with knee OA sample) Lee 
  • Change of 3.5-5.5 points (used CAT with chronic pain sample) Swanholm
  • Change of 3.0-4.5 points (used 10 item short form with cancer sample) Yost
Fatigue
  • Change of 2 points (used 4 item short form with systemic lupus erythematosus sample) Katz
  • Change of 2.5-4.5 points (used 17 item short form) Yost
  • Change of 3.0-5.0 points (used 7 item short form) Yost

Based on Neuro-QoL™ short form, which shares metric with PROMIS Kozlowski:

  • Lower Quartile: Change of 4.7-12.2 points 
  • Middle Half: Change of 4.7 – 5.1 points 
  • Upper Quartile: Change of 5.0-11.3 points 
Gastrointestinal Symptoms 
  • Belly Pain: Change of 6 points Khanna
  • Constipation: Change of 5-6 points Khanna
  • Diarrhea: Change of 5-6 points Khanna
  • Gas and Bloating: Change of 6 points Khanna
  • Reflux: Change of 1 point for worsening, 5 points for improvement Khanna
Pain Interference
  • Change of 3.5-5.5 points (used CAT with back pain samples) Amtmann
  • Change of 2-3 points (used short forms with chronic pain samples) Chen
  • Change of 3.5-4.5 points (used short forms with stroke sample) Chen
  • Change of 2 points (used 4 item short form with systemic lupus erythematosus sample) Katz
  • Change of 2 points (used 4 item short form with rheumatoid arthritis sample) Katz
  • Change of 2.35-2.4 points (used short form with knee OA sample) Lee
  • Change of 4.0-6.0 points (used 10 item short form with cancer sample) Yost
Participation in Social Roles and Activities
  • Change of 1-2 points (used 4 item short form with systemic lupus erythematosus sample) Katz
Physical Function
  • Change of 2 points (used 20 item short form with RA sample) Hays 
  • Change of 1-2 points (used 4 item short form with systemic lupus erythematosus sample) Katz
  • Change of 1.7 points (used Physical Function v1.2 CAT with non-shoulder hand and upper extremity conditions) Kazmers
  • Change of 1.9-2.2 points (used short form with knee OA sample) Lee
  • Change of 3.6 points (Physical Function v1.2/v2 CAT with distal radius fracture sample) Sandvall
  • Change of 4-6 points (used 10 item short form with cancer sample) Yost
  • In a 2018 analysis with patients undergoing total joint replacement, different methods of calculating a meaningful change produced a range of estimates for multiple measures including the PROMIS Physical Function CAT. See Hung et al (2018).
Sleep Disturbance
  • Change of 2.5 points (used 4 item short form with systemic lupus erythematosus sample) Katz
Upper Extremity
  • Change of 2.1 points (used Upper Extremity v1.2 CAT with non-shoulder hand and upper extremity conditions) Kazmers

PROMIS PEDIATRIC MID ESTIMATES

  • Depression: Change of 2-3 points Thissen
  • Pain Interference: Change of 2-3 points Thissen
  • Fatigue: Change of 2-3 points Thissen
  • Mobility: Change of 2-3 points Thissen
  • Morgan and colleagues found that estimates of MIDs varied by domain, the severity of symptom/dysfunction, and by who was making the judgement (pediatric patient, parent, or clinician).

BOOKMARKING METHODS FOR INDIVIDUAL CHANGE

Standard Setting using Bookmarking methods have been used to estimate score cut points (e.g., within normal limits, mild, moderate, severe) at a single point in time. Bingham and colleagues (2021) applied this method to estimate the magnitude of change that was meaningful for making treatment decisions in rheumatoid arthritis. Patients and clinicians agreed about improvement. Patients identified a larger amount of deterioration than clinicians in order to consider a change in therapy. Learn more>>

  • PROMIS Pain Interference
    • Improvement: 10 points (patients and clinicians)
    • Deterioration: 10 points (patients), 5 points (clinicians)
  • PROMIS Fatigue
    • Improvement: 10 points (patients and clinicians)
    • Deterioration: 15 points (patients), 5 points (clinicians)