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Establishing A Minimally Clinically Important Difference Of Movement-Evoked Pain In Musculoskeletal Pain
Abstract   Open access   Peer reviewed

Establishing A Minimally Clinically Important Difference Of Movement-Evoked Pain In Musculoskeletal Pain

Timothy R. Fleagle, Andrew A. Post, Dana L. Dailey, Carol GT Vance, Emine O. Bayman, Leslie J. Crofford, Kathleen A. Sluka and Ruth L. Chimenti
The journal of pain, Vol.24(4), pp.51-51
04/2023
DOI: 10.1016/j.jpain.2023.02.241
url
https://doi.org/10.1016/j.jpain.2023.02.241View
Published (Version of record) Open Access

Abstract

Movement-evoked pain (MEP) is a common complaint of patients with musculoskeletal pain and is considered distinct from resting pain. There is growing interest in measuring MEP as a primary outcome in clinical trials, but no minimally clinically important difference (MCID) has been established, limiting interpretations. We analyzed data from 310 participants who participated in previous clinical trials (65 with chronic Achilles tendinopathy: NCT04059146; 245 with fibromyalgia: NCT01888640) to establish an MCID for MEP. An aggregate MEP score was defined as the average of a participant's pain numeric rating scale (NRS: 0 to 10) during two clinically relevant activities. The MEP change was calculated as the post-intervention minus the pre-intervention score. The global rating of change (GROC: 1 to 7) was completed after the intervention. GROC scores were dichotomized twice into non-responders (GROC≥4) and responders at both minimal (GROC<4) and moderate improvements (GROC<3). The between-group differences in MEP change after treatment were used to define the MCID. Sensitivity and specificity of the MCIDs were calculated using receiving operating characteristic (ROC) curves. The MCID representing minimal improvement was -1.92 (95% CI: -2.43, -1.41) (ROC area under the curve (AUC)= 0.766), sensitivity=44.3%, specificity=89.0%). The MCID representing moderate improvement was -2.39 (95%CI: -2.96, -1.82) (AUC= 0.804), sensitivity=44.3%, specificity=91.8%). The MCID for MEP is similar to the previously established MCID for resting pain of -2. The establishment of an MCID for changes in MEP across musculoskeletal pain conditions and treatments may assist in the interpretation of MEP as a primary outcome in future clinical trials. R00 AR071517, UM1-AR-063381, and UM1-AR-063381-S1.

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