Challenges for defining minimal clinically important difference (MCID) after spinal cord injury.

STUDY DESIGN: This is a review article. OBJECTIVES: This study discusses the following: (1) concepts and constraints for the determination of minimal clinically important difference (MCID), (2) the contrasts between MCID and minimal detectable difference (MDD), (3) MCID within the different domains of International Classification of Functioning, disability and health, (4) the roles of clinical investigators and clinical participants in defining MCID and (5) the implementation of MCID in acute versus chronic spinal cord injury (SCI) studies. METHODS: The methods include narrative reviews of SCI outcomes, a 2-day meeting of the authors and statistical methods of analysis representing MDD. RESULTS: The data from SCI study outcomes are dependent on many elements, including the following: the level and severity of SCI, the heterogeneity within each study cohort, the therapeutic target, the nature of the therapy, any confounding influences or comorbidities, the assessment times relative to the date of injury, the outcome measurement instrument and the clinical end-point threshold used to determine a treatment effect. Even if statistically significant differences can be established, this finding does not guarantee that the experimental therapeutic provides a person living with SCI an improved capacity for functional independence and/or an increased quality of life. The MDD statistical concept describes the smallest real change in the specified outcome, beyond measurement error, and it should not be confused with the minimum threshold for demonstrating a clinical benefit or MCID. Unfortunately, MCID and MDD are not uncomplicated estimations; nevertheless, any MCID should exceed the expected MDD plus any probable spontaneous recovery. CONCLUSION: Estimation of an MCID for SCI remains elusive. In the interim, if the target of a therapeutic is the injured spinal cord, it is most desirable that any improvement in neurological status be correlated with a functional (meaningful) benefit.

Accelerated recovery following polyamines and aminoguanidine treatment after facial nerve injury in rats.

Accelerated axon regeneration is of paramount importance for improved functional recovery after motor nerve injuries. Following injury of their axon neurones undergo a series of changes, termed the axon reaction, aimed at survival and regeneration of a new axon. We and others have found that early treatment with exogenous polyamines can enhance neuronal survival and accelerate the rate of axon regeneration and functional recovery after sympathetic and motor (sciatic) nerve injuries. Results of the present study corroborate the previous findings and demonstrate that after facial nerve injury in adult rats, polyamine treatment can accelerate the early phases of motor function recovery (vibrissae movement). Treatment with aminoguanidine, an inhibitor of several oxidation reactions, produced a further improvement at the early phase of functional recovery. In the facial nucleus, the injury-induced transient reduction in the activity of the acetylcholine synthesizing enzyme choline acetyltransferase was not affected by the treatment. After nerve injury in 5-day-old male rats, polyamines and aminoguanidine treatment exerted a minor neuroprotective effect (127.6% surviving neurones compared to control). We conclude that polyamines and aminoguanidine may have therapeutic potential in the acceleration of recovery after nerve injuries.