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Table 1 Studies determining minimal clinically important difference as a mean changea (35 studies, 7894 patients)

From: Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain

Study n Patient characteristics Methodological characteristics MCID
   Clinical condition Age, years (range)b Male sex, % Baseline pain, mm Pain scale Transition scale (directionality, categories) Follow-up (Analysis adjusted)c Category defining MCID Absoluted mm (95% CI) Relativee % (95% CI)
Aicher [25] 1743 Headache 38h (16–72) 24 64 VAS 1-sided, 4 cat Single Less good efficacy 27 (25–29) NR
Bailey [26] 202 Mixedg 12 (8–17) 57 NR NRS 2-sided, 5 cat Single A little better 10 (0–20)h NR
Barton 2002 (reported in Jensen 2002 [43]) 125 Post-operation pain (laparotomy) 41 0 NR VAS 1-sided, 5 cat Multiple (unclear) A little relief 9 (7–12) 13 (8–17)
Bernstein [27] 135 Unspecified 42 (21–65) 45 100h NRS 1-sided, 5 cat Single A little relief 21 (18–24) NR
Bijur [28]f 108 Unspecified 44 (21–85) 40 73 VAS + NRS 2-sided, 5 cat Multiple (no) A little less pain 16 (11–21) 22 (15–28)
Bijur [29]f 195 Unspecified 74 27 74 NRS 2-sided, 5 cat Multiple (yes) A little less pain 15 (14–17) 24 (21–27)
Bijur [30]f 214 Unspecified 74 34 86 NRS 2-sided, 5 cat Multiple (yes) A little less pain 14 (12–15) 22 (19–25)
Bird [31] 77 Isolated extremity trauma 38 62 52 VAS 2-sided, 5 cat Multiple (no) A little less pain 20 (15–25) NR
Bulloch [32] 121 Mixedg (65% traumatic, 35% non-traumatic) 10 (5–16) 56 60h VAS 2-sided, 5 cat Multiple (no) A little less pain 17 (11–23) NR
Cepeda [33] 700 Post-operation pain (mixed) 41 (16–88) 38 79 NRS 1-sided, 5 cat Multiple (yes) Minimal improvement 17 (10–20)h 20 (13–30)h
Chow [34] 105 Pain flare after radiotherapy 70h 56 50 NRS 2-sided, 3 cat Multiple (no) Better 23 (20–26) NR
Degerli [35] 306 Thoraco-abdominal pain (non-traumatic) 42 (17–83) 40 67 VAS 2-sided, 5 cat Multiple (no) A little less pain 25 (23–26) NR
Farrar [36] 134 Cancer-related breakthrough pain 55 (21–87) 53 NR NRS 1-sided, 5 cat Multiple (yes) Slight relief 13–19j 16–34j
Fosnocht [37] 1490 Mixedg 36 (18–89) 47 63 VAS 2-sided, 5 cat Multiple (no) A little less pain 21 (19–23) NR
Gallagher [38]f 96 Mixedg 37 (19–71) 45 64 VAS 2-sided, 5 cat Multiple (yes) A little less pain 15 (11–18) 17 (6–29)
Gallagher [39]f 101 Abdominal pain 40 (15–88) 39 65 VAS 2-sided, 5 cat Multiple (yes) A little less pain 18 (14–21) 23 (12–33)
Grilo [40] 50 Rheumatic conditions 49 (16–85) 44 78 VAS 1-sided, 5 cat Single Moderate relief 40i NR
Grotle [41] 54 Acute low back pain 38 27 39 VAS + NRS 2-sided, 6 cat Single Slightly improved 34 (20–48)  
Holdgate [42]f 79 Unspecified 53 (21–93) NR 54 VAS + NRS 2-sided, 5 cat Multiple (yes) A bit better 16 (12–20) 34 (27–41)
Kelly [44] Kelly [45, 46] 156 Mixedg (43% traumatic, 57% non-traumatic) 44 (16–97) 56 51 VAS 2-sided, 5 cat Multiple (unclear) A little better 8 (4–12) NR
Kendrick 2005 [47] 356 Mixedg (35% traumatic, 65% non-traumatic) 41h 42 66 NRS 2-sided, 5 cat Multiple (no) A little less pain 15 (13–16) NR
Lopez [21] 74 Sickle cell crisis NR NR 79 VAS 2-sided, 5 cat Multiple (no) A little better 14 (11–16)h,k NR
Mark [48] 186 Unspecified 49 (15–87) 38 65 VAS 2-sided, 5 cat Single A little better 17 (14–20)k NR
Martin [49] 95 Third molar extraction 30 40 33 VAS 2-sided, 7 cat Single Much improved or best ever 23i 72i
Martin [49] 63 Third molar extraction 25 40 35 Do Do Do Do 25i 69i
Martin [49] 62 Third molar extraction 27 50 30 Do Do Do Do 29i 85i
McConahay [50] 126 Mixedg (48% traumatic, 52% non-traumatic) 9 (5–12) 56 83 VAS 2-sided, 5 cat Single A little less pain 24 (17–31) NR
Mohan [51]f 125 Unspecified 35h 44 46 VAS + NRS 2-sided, 5 cat Multiple (yes) A bit better 13 (9–17) 18 (1–35)
Myrvik [52] 28 Sickle cell crisis 15 (8–18) 50 75h VAS + NRS 2-sided, 5 cat Multiple (unclear) A little better 10 (4–15) NR
Powell [53] 73 Mixed (63% traumatic, 37% non-traumatic) 12 (8–15) NR 60 VAS 2-sided, 5 cat Multiple (yes) A bit better 11i NR
Rasmussen 2002 (reported in Jensen 2002 [43]) 123 Post-operation pain (knee surgery) 65 34 NR VAS 1-sided, 5 cat Multiple (unclear) A little relief 13 (10–17) 18 (14–22)
Sloman [54] 150 Post-operation pain (mixed) 47 (14–89) 53 67 NRS 1-sided, 5 cat Single Minimal relief 18i 36 (21–51)
Stahmer [55] 81 Mixedg (31% traumatic, 69% non-traumatic) 38 (16–87) 44 68 NRS 1-sided, 5 cat Single Some relief or partial relief NR 30 (18–42)
Todd [56] 48 Trauma 35h (17–76) 69 56 VAS 2-sided, 5 cat Multiple (no) A little less pain 16 (10–22) NR
Voepel-Lewis [59] 113 Post-operation pain (e.g. spinal fusion, splenectomy) 13 (7–16) 43 NR NRS 2-sided, 5 cat Multiple (yes) A little better 10 (5–15) NR
  1. aMean change in pain score among patients with minimum improvement of pain
  2. bMean (range) if not otherwise indicated,
  3. cEstimate based on single or multiple follow-up measurements (were standard errors adjusted for dependency between multiple measurements?)
  4. dAbsolute = mm reduction on a 100 mm scale
  5. eRelative = % reduction from baseline
  6. fIndividual patient data provided by authors
  7. gMixed patient population recruited at Hospital Emergency Department
  8. hData is median (inter-quartile range)
  9. i95% CI unavailable
  10. jEstimates for subgroups with different baseline pain
  11. kPatients with minimal improvement and worsening of pain were combined
  12. MCID minimum clinically important difference, VAS visual analogue scale, NRS numeric rating scale, CI confidence interval, NR not reported