Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures

Caroline B. Terwee*, John Devin Peipert, Robert Chapman, Jin Shei Lai, Berend Terluin, David Cella, Philip Griffith, Lidwine B. Mokkink

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

49 Scopus citations


We define the minimal important change (MIC) as a threshold for a minimal within-person change over time above which patients perceive themselves importantly changed. There is a lot of confusion about the concept of MIC, particularly about the concepts of minimal important change and minimal detectable change, which questions the validity of published MIC values. The aims of this study were: (1) to clarify the concept of MIC and how to use it; (2) to provide practical guidance for estimating methodologically sound MIC values; and (3) to improve the applicability of PROMIS by summarizing the available evidence on plausible PROMIS MIC values. We discuss the concept of MIC and how to use it and provide practical guidance for estimating MIC values. In addition, we performed a systematic review in PubMed on MIC values of any PROMIS measure from studies using recommended approaches. A total of 50 studies estimated the MIC of a PROMIS measure, of which 19 studies used less appropriate methods. MIC values of the remaining 31 studies ranged from 0.1 to 12.7 T-score points. We recommend to use the predictive modeling method, possibly supplemented with the vignette-based method, in future MIC studies. We consider a MIC value of 2–6 T-score points for PROMIS measures reasonable to assume at this point. For surgical interventions a higher MIC value might be appropriate. We recommend more high-quality studies estimating MIC values for PROMIS.

Original languageEnglish (US)
Pages (from-to)2729-2754
Number of pages26
JournalQuality of Life Research
Issue number10
StatePublished - Oct 2021


  • Interpretation
  • Methodology
  • Minimal important change
  • Patient-reported outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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