Things aren’t always as they appear, and that’s certainly true when it comes to measuring the success of rehab therapy treatment. As any therapist knows, if you make decisions based on observational data alone, determining whether or not your treatment is making a difference can prove difficult. That’s why outcomes exist: they give therapists an objective, concrete way to measure patient improvement. But, a positive outcome score isn’t necessarily enough to tell you that your physical therapy treatment is effective. That’s where minimal clinically important differences (MCIDs) come into the picture.

What are MCIDs?

Tracking Patient Improvement

MCIDs are research values are that crucial to determining the efficacy of any given treatment modality or plan. In terms of physical therapy outcomes, MCIDs represent the minimum outcomes score change patients should experience in order for them, their providers, or other overseeing bodies to confirm that therapy is creating a positive difference.

Here are the MCIDs for a few common outcome measurement tools in rehab therapy:

Outcome Measurement Tool

Minimal Clinically Important Difference (MCID)

Lower Extremity Functional Scale (LEFS)

⇧ Increase of 9 points

Modified Oswestry Disability Index (ODI)

⇩ Decrease of 12%

QuickDASH (Disabilities of the Arm, Shoulder, and Hand)

⇩ Decrease of 18 points

Dizziness Handicap Inventory (DHI)

⇩ Decrease of 18 points

Neck Disability Index (NDI)

⇩ Decrease of 5 points

For example: Let’s say you’re treating a patient for chronic neck pain. You might use the Neck Disability Index to measure the patient’s initial level of disability and track his or her progress. Let’s also say that the patient began therapy with an NDI score of 33—which denotes “severe disability.” But over time, the patient’s score decreases to 26. In this scenario, 26 is still considered “severe disability”; however, the seven-point drop indicates a meaningful, objective, and measurable change, because it exceeds the MCID for the Neck Disability Index (which is a decrease of five points).

Why are they important?

Preventing Patient Dropout

Let’s face it: physical therapy isn’t exactly a cake walk for many patients. Sometimes, it can feel like an uphill battle, particularly if a patient doesn’t notice any significant improvement. When this happens, patients might disappear from therapy before they’ve completed treatment. However, if a patient is meeting the MCIDs for applicable outcome measures, you can prove to him or her that therapy is actually working—even if he or she hasn’t noticed a difference yet.

Updating Treatment Plans

While MCIDs can be instrumental in demonstrating the efficacy of therapy to patients, they can also play a crucial role in helping providers identify points along the course of care at which a patient’s treatment plan is in need of adjustment. As a provider, you can catch ineffective—or even contradictory—interventions by assessing the patient’s progress at regular intervals and comparing his or her outcomes to the applicable MCIDs.

You can’t always take things at face value. Just because you don’t observe a major change from week to week during the course of therapy treatment, it doesn’t mean improvement is non-existent. That’s why tracking outcomes is crucial to delivering meaningful results through evidence-based treatment interventions and modalities. By using MCIDs and outcomes in tandem, you can ensure that you’re delivering the best possible care to every patient—every time.