The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis

Gray, Alan; Huston, Molly N.; Didericksen, Devin; Meyer, Tanya K.; Meratı, Albert L.; Brisebois, Simon

doi:10.1002/lary.28331

Cited by 6 publications

(9 citation statements)

References 28 publications

(59 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gray et al recently cited the minimal clinically important difference in the DI to be 4 for patients with laryngotracheal stenosis undergoing airway surgery. 22 The observed mean change here of 5 would be just above that threshold, at least at short-term follow-up, though the specific minimal clinically important change in UVFP is unknown. For patients with baseline dyspnea or for whom an increase in dyspnea is a main concern, trial saline injection augmentation 23 or short-acting injection augmentation could be considered.…”

Section: Discussionmentioning

confidence: 74%

“…Importantly, only 6 of 43 patients had an increased DI score after intervention, with a change from 6 ± 9 to 11 ± 8. Gray et al recently cited the minimal clinically important difference in the DI to be 4 for patients with laryngotracheal stenosis undergoing airway surgery 22 . The observed mean change here of 5 would be just above that threshold, at least at short‐term follow‐up, though the specific minimal clinically important change in UVFP is unknown.…”

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Hoffman

Vandiver

Derise

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment. Study Design Retrospective review. Setting Academic medical center. Methods Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI. Results Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( P < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI. Conclusion Upper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.

show abstract

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 89%

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Hoffman

Vandiver

Derise

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…When serially following a patient, the change in DI score can discriminate between those experiencing a significant change in their level of dyspnea and those who do not (minimal clinically important difference of 4). 23 Clinically, however, we have observed a mismatch between the clinicianreported degree of stenosis and patients' DI scores. In order to better understand this, we set out to determine how well clinician-reported degree of stenosis predicted the variation in patients' reported degree of dyspnea.…”

Section: Introductionmentioning

confidence: 77%

Pulmonary Function Tests May Better Predict Dyspnea-Severity in Patients with Subglottic Stenosis Compared to Clinician-Reported Stenosis

Bhatt

Huang

Bertelsen³

et al. 2021

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: Patients with subglottic stenosis (SGS) present with varied degree of breathing complaints. The dyspnea index (DI) is a 10-question patient-reported outcome measure designed to measure the severity of upper airway obstruction. We set out to determine whether pulmonary function tests or clinician-reported degree of stenosis best predicted DI scores. Methods: Thirty patients with SGS were retrospectively reviewed over a 6-year period. One visit from each patient was included. Data including peak expiratory flow rate (PEFR), body-mass index (BMI), clinician-reported degree of stenosis, and DI scores were reviewed. Multiple linear regression was performed to determine how degree of stenosis and PEFR % predicted the variation in DI score. Results: PEFR % better predicted DI scores compared to degree of stenosis (partial correlation −0.32 vs 0.17). After stepwise elimination, PEFR % remained in the regression and was significantly associated with DI scores ( F[1, 29] = 9.38, P = .005). BMI did not demonstrate a linear relationship with DI scores and was not included in the regression ( r = −.02). The PEFR % unstandardized coefficient was −0.25 (95% CI: −0.42 to −0.08, P = .005). The model predicts that a 4% increase in the PEFR % results in a 1-point decrease in the DI score (95% CI: −1.68 to −0.32). Conclusion: This study suggests that pulmonary function tests may be a better in-office measure to substantiate the severity of symptoms in patients with SGS.

show abstract

“…Five studies (Table I and Table II, top) reported MCID of objective outcome measurements/tests (vestibuloocular reflex gain, 14 peak nasal expiratory flow, 15 peak nasal inspiratory flow, 15,16 Brief Smell Identification Test, 17 and laryngotracheal stenosis 18 ). In comparison, 30 studies reported 45 PROM MCID values (Table I and Table II, bottom) 19–48 . While all studies reported the MCID for improvement in an outcome, only five studies (17.2%) also reported an MCID for worsening in an outcome 24,33,39,41,45 …”

Section: Resultsmentioning

confidence: 99%

Variability in Minimal Clinically Important Difference Calculation and Reporting in the Otolaryngology Literature

Tripathi,

Min,

Cody

et al. 2023

The Laryngoscope

View full text Add to dashboard Cite

ObjectiveBest practices for calculation of the minimal clinically important difference (MCID) of outcome measures include the use of complementary methodologies (broadly classified as anchor‐based and distribution‐based) and reporting of the MCID's predictive ability. We sought to determine MCID calculation and reporting patterns within the otolaryngology literature.MethodsA systematic search strategy of Embase, PubMed, and Web of Science databases was developed and implemented to identify studies reporting the determination of an MCID for an outcome measure. Studies specifically within the otolaryngology literature (defined as journals classified as “otorhinolaryngology” in the Journal Citation Reports database) were included. All those journals were additionally searched for relevant articles.ResultsThere were 35 articles that met the inclusion criteria. Of these studies, 88.6% reported MCID of a patient‐reported outcome measure and the remainder were for objective outcome measurements. Anchor‐based methods were used by 82.9% of studies and distribution‐based methods were used by 68.6% of studies. Of all studies, 31.4% utilized anchor‐based methods alone, 17.1% utilized distribution‐based methods alone, and 51.4% used both methods. Only 25.7% of studies reported the sensitivity (median: 60.8%, range: 40.5%–86.7%) and specificity (median: 80.4%, range: 63.5%–88.0%) of the MCID to detect patients experiencing clinically important change.ConclusionDeviation from best practices in MCID calculation and reporting exists within the otolaryngology literature, with almost half of all studies only using one method of MCID calculation and almost three‐quarters not reporting the predictive ability (sensitivity/specificity) of the calculated MCID. When predictive ability is reported, however, MCIDs appear to be more specific than sensitive.Level of EvidenceNA Laryngoscope, 2023

show abstract

The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis

Cited by 6 publications

References 28 publications

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Pulmonary Function Tests May Better Predict Dyspnea-Severity in Patients with Subglottic Stenosis Compared to Clinician-Reported Stenosis

Variability in Minimal Clinically Important Difference Calculation and Reporting in the Otolaryngology Literature

Contact Info

Product

Resources

About