Who should judge treatment effects as unimportant?

Journal of Physiotherapy

Abstract

It is common to encounter authors of trials, systematic reviews and guidelines dismissing treatments on the grounds that their effects are not large enough to be worthwhile. The basis is often as simple as the treatment effect not surpassing a standard benchmark, such as 15 units on a 0 to 100 pain scale. We have been guilty of this practice ourselves, but now realise that things are more complex. This Editorial begins with a brief introduction to the smallest worthwhile effect, also referred to as the minimum clinically important difference. It then explains the limitations of the standard benchmark approach and proposes a more nuanced approach that considers the complexity of the clinical encounter and the wishes of the patient. An example from pain research is used.