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Minimally clinically important difference in chronic breathlessness: every little helps

Oxberry, Stephen G.; Bland, J. Martin; Clark, Andrew L.; Cleland, John G.F.; Johnson, Miriam


Stephen G. Oxberry

J. Martin Bland

Andrew L. Clark

John G.F. Cleland


ObjectivesThe aim of the study was to determine the minimally clinically important difference (MCID) for breathlessness due to chronic heart failure (CHF). BackgroundThe measurement of breathlessness is difficult because it is subjective and multifactorial. Statistically significant changes in assessment may not be clinically meaningful. This is the first determination of MCID in chronic breathlessness in CHF using patient-rated data. MethodsMeasurements were made as part of a randomized, controlled, crossover trial of morphine, oxycodone, or placebo for breathlessness in CHF. Breathlessness intensity was assessed at baseline and at the end of each intervention (day 4) using 11-point numerical rating scales (NRS), modified Borg (mBorg) scales, and global impression of change (GC) in breathlessness at day 4. From these data, the change in NRS or mBorg associated with a 1-point change in GC was calculated. ResultsThirty-five patients completed all study interventions, resulting in 105 data sets. We defined MCID as a 1-point change in GC. Regression analysis found that the MCID, including 95% CIs, equaled change in average NRS breathlessness per 24 hours of 0.5 to 2.0 U (P < .001), change in worst NRS breathlessness per 24 hours of 0.4 to 2.9 (P < .001), change in average mBorg score of 0.2 to 2.0 (P < .001), and change in worst mBorg score as between 0.3 and 1.9 (P < .001). Corresponding effect size calculations lay within the 95% CIs for the regression analysis for each measure.


Oxberry, S. G., Bland, J. M., Clark, A. L., Cleland, J. G., & Johnson, M. (2012). Minimally clinically important difference in chronic breathlessness: every little helps. American Heart Journal, 164(2), 229-235.

Journal Article Type Article
Acceptance Date May 11, 2012
Online Publication Date Aug 8, 2012
Publication Date Dec 31, 2012
Journal American Heart Journal
Print ISSN 0002-8703
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 164
Issue 2
Pages 229-235
Keywords Cardiology and Cardiovascular Medicine
Public URL
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