Minimal important difference

I cover topical NSAIDs, platelet-rich plasma, quote, unquote, "regenerative medicine" and urtication, intentionally stinging yourself with nettles.

Also, the chapter includes four important concepts, MCID, what it means to achieve a minimal clinically important difference when it comes to pain, regression to the mean, a, a concept that is at once so trivial that it is blindingly obvious, and so deep that many scientists spend their whole career being fooled by it.

The healthy user effect, which can make supplements appear more useful than they are, and the placebo effect, how real it is, and how surprisingly common it is for doctors to use it to effectively deceive patients.

In the rheumatoid arthritis chapter, I cover traditional Chinese medicine, introduce elimination diets, including fasting, and explore three overlooked sources of inflammation, Neu5Gc, endotoxins, and sodium versus potassium intake.

And they showed that a significant reduction in pain intensity and interference at six months was seen.

It was statistically significant, but it wasn't clinically meaningful because they didn't get to the level of change that was beyond the MCID, the minimal clinically important difference of one point in their outcome measure.

It failed to do that.

So the question is, I know we talk about mindfulness all the time.

A paired t-test demonstrated a significant difference between pre- and post-intervention scores, and the scenario actually gave us, like, mock values for that.

And then it said the mean improvement was 2.8 points, and the reported MCID for the outcome in the study was 3.0 points.

And so it was very, very realistic, very real life, like what you would get out of a journal article.

And so there were some great questions that came out of that, like which interpretation of statistical analysis is most appropriate? And then it gave you four different options.

Maybe what we can do, Sarah, is maybe we can use these test questions for our test question Friday this week, because I thought that they were really good.

And like you said, Helen, they really were interesting.

the type of information from a research article that we need as a PCS level practitioner, right? Like I do think that there's a difference between maybe how I'm critiquing an article at like a PhD comp exam level versus compared to what you need to do as a clinician to be able to say, like, how do I use this article in my practice? Like, what does this information give me that changes what I'm going to do Monday with my patient in the clinic? So thinking about things like those MCIDs and understanding those types of things and whether the research made sense and whether the effect size was Was the correct effect size to really tell us that this is meaningful and worthwhile doing on Tuesday in the clinic? I think are the things that we really want to be able to take away from literature.

And one of the recommendations of the bodies that do the tests is to really be up to date on the recent literature, to really spend some time like on APTA Pediatrics, going through the Pediatrics Journal, maybe thinking about I always think about like the last like eight years to like the last like four years, you know, keeping it in that range where it's not something that was published last week, but really being able to go through some of those articles from like 2022 and making sure that you can understand what those statistics were telling you, I think is a really important skill to be able to have.

Anti-anginal drugs typically improve modified Bruce Protocol treadmill testing against placebo, like sugar pill, by something like 40 to 45 seconds.

So when Daryl Francis did Orbita 1, he powered his study to detect a 30-second difference in modified Bruce Protocol treadmill test, which is smaller than acne and smaller than ranolazine and smaller than even what cardiologists thought was the minimally clinically important difference, the MCID.

And what he actually detected in the study, it's not significant, was a 16-second difference.

That stenting actually had a 16-second modified Bruce protocol treadmill test benefit over not stenting.

I, I, I hope this becomes clear why, why the song during the course of this.

I wanna talk about MCID, CSD, TPP.

Now, we have a big problem in clinical trials that we have so many acronyms, and it actually gets in the way of the science at times, where when somebody says an acronym, I say CSD, somebody else hears that, and it ha- it has a meaning to them.

That may not be the meaning that I gave to that, and I'll, I'll come back to that as well.

Uh, uh, cl- uh, s- um, uh, c- uh, clinically meaningful, uh, minimally clinically meaningful difference is another one.

TPP is target product profile, and we'll talk about what that means.

The, the goal of this CSD or MCID, minimally clinically significant difference, is really about thinking about an endpoint and what value of that endpoint clinically makes a difference.

And this is a concept that shows up over and over and over again, and it's used again in many different ways within clinical trials.