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Clinically important change in quality of life in epilepsy
  1. S Wiebe1,
  2. S Matijevic3,
  3. M Eliasziw1,
  4. P A Derry2
  1. 1Departments of Clinical Neurological Sciences and Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
  2. 2Department of Psychology, University of Western Ontario
  3. 3London Health Sciences Centre, London, Ontario
  1. Correspondence to:
 Dr S Wiebe, London Health Sciences Centre, University Campus, 339 Windermere Rd, London, Ontario, Canada N6A 5A5;


Background: Health related quality of life (HRQOL) is increasingly recognised as an important outcome in epilepsy. However, interpretation of HRQOL data is difficult because there is no agreement on what constitutes a clinically important change in the scores of the various instruments.

Objectives: To determine the minimum clinically important change, and small, medium, and large changes, in broadly used epilepsy specific and generic HRQOL instruments.

Methods: Patients with difficult to control focal epilepsy (n = 136) completed the QOLIE-89, QOLIE-31, SF-36, and HUI-III questionnaires twice, six months apart. Patient centred estimates of minimum important change, and of small, medium, and large change, were assessed on self administered 15 point global rating scales. Using regression analysis, the change in each HRQOL instrument that corresponded to the various categories of change determined by patients was obtained. The results were validated in a subgroup of patients tested at baseline and at nine months.

Results: The minimum important change was 10.1 for QOLIE-89, 11.8 for QOLIE-31, 4.6 for SF-36 MCS, 3.0 for SF-36 physical composite score, and 0.15 for HUI-III. All instruments differentiated between no change and minimum important change with precision, and QOLIE-89 and QOLIE-31 also distinguished accurately between minimum important change and medium or large change. Baseline HRQOL scores and the type of treatment (surgical or medical) had no impact on any of the estimates, and the results were replicated in the validation sample.

Conclusions: These estimates of minimum important change, and small, medium, and large changes, in four HRQOL instruments in patients with epilepsy are robust and can distinguish accurately among different levels of change. The estimates allow for categorisation of patients into various levels of change in HRQOL, and will be of use in assessing the effect of interventions in individual patients.

  • quality of life
  • epilepsy
  • HRQOL, health related quality of life
  • HUI, health utilities index
  • MCS, mental composite score of SF-36
  • MIC, minimum clinically important change
  • PCS, physical composite score of SF-36
  • QOLIE, quality of life in epilepsy inventory
  • SF-36, medical outcomes study short form questionniare

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