Feeling good rather than feeling better matters more to patients
Article first published online: 27 JUL 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis Care & Research
Volume 55, Issue 4, pages 526–530, 15 August 2006
How to Cite
Tubach, F., Dougados, M., Falissard, B., Baron, G., Logeart, I. and Ravaud, P. (2006), Feeling good rather than feeling better matters more to patients. Arthritis & Rheumatism, 55: 526–530. doi: 10.1002/art.22110
- Issue published online: 27 JUL 2006
- Article first published online: 27 JUL 2006
- Manuscript Accepted: 9 DEC 2005
- Manuscript Received: 11 JUL 2005
- Merck Sharp and Dohme Chibret, Paris, France
- Minimal clinically important improvement;
- Patient acceptable symptom state;
- Patient's perspective;
- Outcome criteria
To determine the most appropriate means to assess the response to treatment in terms of pain and functional impairment in a chronic rheumatic condition (knee osteoarthritis [OA]) and an acute rheumatic condition (rotator cuff syndrome [RCS]).
Two prospective studies were conducted consisting of 1,019 outpatients with knee OA and 271 patients with acute RCS. The minimal clinically important improvement and the patient acceptable symptom state were determined for knee OA pain using a visual analog scale, and for knee OA function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale; for acute RCS pain, a numeral rating scale was used, and the Neer function subscale was used for RCS function.
The minimal clinically important improvement was shown to be the change required to achieve the patient acceptable symptom state, whatever the baseline level of symptom, the outcome (pain or function), or type of condition (chronic or acute). This acceptable state for pain was higher for chronic (27.0–36.4 across the baseline score) than acute (16.7–24.1) conditions. The level of functional impairment considered satisfactory by patients with knee OA was higher for more disabled patients (43.1) than for less disabled patients (20.4).
Patients consider that they experienced an important improvement only if this improvement allowed them to achieve a state they consider satisfactory. The most appropriate means to assess the response to therapy seems to be to assess whether patients feel good (i.e., achieve the patient acceptable symptom state).