MCID: Minimal Clinically Important Difference
MCID or minimal clinically important difference is a standard for evaluating the effectiveness of treatment. If you aren’t using standardized outcome measures in your practice, now is the time to make a change.
Summary
- MCID reflects the smallest change in a score that a patient perceives as beneficial. It emphasizes clinical significance over mere statistical significance—focusing on real-world improvements that actually matter to the client.
- Incorporating validated outcome measures into practice supports evidence-based care, improves treatment planning, and provides a measurable way to justify therapy to insurers and patients alike. Reliable outcome tools with established MCIDs can guide more meaningful interventions.
- MCID is typically established using distribution-based methods (linked to statistical variation) and anchor-based methods (tied to external benchmarks like patient perception) Both have strengths, and using both can increase confidence in outcome interpretation.
- Therapists can use MCID values to set treatment goals tied to meaningful change, motivate clients through gamified progress, show treatment effectiveness to payers and support the need for continued care when improvements haven’t yet met MCID thresholds. Clinicians can keep track of their treatment goals through an EHR like TheraPlatform.
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Standardized outcome measures are an important part of evidence-based practice and can provide valuable information, inform treatment decisions and justify services to payer sources. A standardized outcome measure is a set of subjective questions or objective exam items administered in a specific manner to standardize the interpretation of the results. Most standardized outcome measures end in a total score and/or domain scores which have clinical meaning.
A quick web search for standardized outcome measures related to physical therapy can leave you dizzy from the choices. Anyone can create a standardized outcome measure but gleaning valuable information from their results necessitates further research and testing.
For example, the geriatrics section of the APTA reviewed 107 outcome measures related to balance and fall risk assessment in 2020 to help clinicians decide which outcome measures to use.
Selecting outcome measures that have been well-validated by research improves confidence in the clinical decisions we make based on the results of these measures.
Cut-off scores, normative values, minimal clinically important difference and minimal detectable change are values you should reference when interpreting the score of an outcome measure and using it to guide a plan of care.
In this article, we will investigate the MCID or minimal clinically important difference and outline how to use this value in your clinical decision-making.
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Minima Clinically Important Difference (MCID)
Trends in research statistics have been shifting from the focus on statistical significance to clinical significance. A highly powered study with generally beneficial results is likely to reach statistical significance but the value of that change cannot be described solely by the level of statistical significance.
The MCID defines a change in score which represents the smallest benefit of value to patients. In other words, a change in score equal to the MCID suggests the patient experienced the smallest meaningful change in the outcome of interest.
Score changes smaller than the MCID suggest the change is too small to be beneficial, whereas changes larger than the MCID suggest a greater benefit to the patient. The MCID can be calculated through different methods and is often specific to patient demographics like age or disease process.
The MCID is intended to be a patient-centered concept. The value represents both the magnitude of improvement a patient experienced in response to a treatment intervention while also taking into account the value the patient places on the change.
Let’s consider an imaginary outcome measure called “The OM Test.” The OM Test is scored from 0-100 with scores of 0 equalling full bodily function and scores of 100 equalling severe disability.
If a patient experiences a change of 10 points following treatment, is that meaningful? Insignificant? What about a change of 20 points or 35 points? At what point value does the patient notice a meaningful or clinically important difference in their level of bodily function? That value is the MCID.
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There are two common methods for determining the MCID.
At this time, there is no certain agreement on which approach is best but there are benefits and drawbacks to each.
- The first method relies on a distribution-based approach. In this approach the MCID is referenced to a measure of variability like the standard error of the mean or an effect size in the measure of interest.
- The second method is an anchor-based method. This method references the MCID to an external assessment of change in the measure of interest. Some researchers propose using multiple methods to help “triangulate” the value of the MCID.
Not every outcome measure has an established MCID but many outcome measures and objective tests used in physical therapy do.
Below are examples of MCID values for some outcome measures used commonly by physical therapists:
Measures | MCID |
|---|---|
Oswestry Disability Index for low back pain | 12.8-12.88 points |
Disability of Arm, Shoulder and Hand (DASH) for adults with upper extremity musculoskeletal problems | 10.2 points |
10 Meter Walk Test for geriatrics | Small meaningful change = 0.05 m/s Substantial meaningful change = 0.13 m/s |
Minimal Detectable Change
When searching for the MCID of a particular outcome measure you may come across the term “MCD.” While similar looking, the MCD (minimal detectable change) and MCID are quite different.
Unlike MCID which describes both the magnitude of change and the value of a change in score, the MCD simply describes the minimum change in a patient’s score that can be detected which ensures the change is not simply the result of measurement error. Like the MCID, the MCD has not been established for all outcome measures, but can be useful when evaluating the change in a patient’s score.
How to use the MCID
When available, the MCID can be a useful tool for goal setting and treatment planning. If you know the MCID for a particular outcome measure, you can use this value to set a goal to increase or decrease a patient’s score by that amount within a certain time. This helps to ensure that you are not just looking for a change in score but a change that is meaningful and valuable for patients.
Also, by citing the MCID you can demonstrate the effectiveness of your treatment to patients and payer sources. Patients that are motivated by gamification strategies may work harder to achieve a meaningful change in their outcome measure scores.
Additionally, you can demonstrate the effectiveness of your therapy to insurance companies by achieving a score change that reaches the MCID or alternatively using the gap between the current score and the MCID to justify the need for continuing care.
In summary, trends in statistical research have been supporting the importance of clinical significance over statistical significance. Values like the minimal clinically important difference combine the magnitude of a change in score with the value a patient will find in that change.
Combining objective changes with patient values helps to guide better clinical decision-making and patient-centered care. Most therapists incorporate standardized outcome measures into their practice, but may have never considered the value of using the MCID to set goals and evaluate the effectiveness of their care.
Through a little research and practice with these values, however, we can all elevate our patient care and clinical decisions.
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References
Disabilities of the arm, shoulder, and hand questionnaire. (2021, October 17). Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/disabilities-arm-shoulder-and-hand-questionnaire
Malec, J. F., & Ketchum, J. M. (2020). A Standard Method for Determining the Minimal Clinically Important Difference for Rehabilitation Measures. Archives of physical medicine and rehabilitation, 101(6), 1090–1094. https://doi.org/10.1016/j.apmr.2019.12.008
Minimal clinically important difference: defining what really matters to patients. (n.d.). McGraw Hill Medical. https://jamaevidence.mhmedical.com/content.aspx?bookid=2742§ionid=233567395
Oswestry Disability Index. (2013, November 27). Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/oswestry-disability-index
Statistical terms & use. (2016, October 27). Shirley Ryan AbilityLab. https://www.sralab.org/statistical-terms-use
Wang-Hsu, E., Balance & Falls Special Interest Group (BFSIG) of APTA Geriatrics, American Physical Therapy Association (APTA), University of Pennsylvania Health System, Moyer, H., Casanova Abbott, C., Reilley, A., Glenney, S., Wingood, M., Allison, R., Dhingra, H., Phillips, E., Nesser, H., Graul, P., Subramani, S., Bell, A., & Vincenzo, J. (2019). Outcome Measure Toolkit for Geriatric Fall/Balance Assessment.
10 meter walk test. (2014, January 22). Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/10-meter-walk-test
