Minimal important difference and patient acceptable symptom state for PFDI-20 and POPDI-6 in POP surgery

Päivi K. Karjalainen, Nina K. Mattsson, Jyrki T. Jalkanen, Kari Nieminen, Anna-Maija Tolppanen

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Introduction and hypothesis: Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as important. The Patient Acceptable Symptom State (PASS) represents the value of score beyond which patients consider themselves well. We aimed to determine the MID and PASS for Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) in pelvic organ prolapse (POP) surgery. Methods: We used data from 2704 POP surgeries from a prospective, population-based cohort. MID was determined with three anchor-based and one distribution-based method. PASS was defined using two different methods. Medians of the estimates were identified. Results: The MID estimates with (1) mean change, (2) receiver-operating characteristic (ROC) curve, (3) 75th percentile, and (4) distribution-based method varied between 22.9–25.0 (median 24.2) points for PFDI-20 and 9.0–12.5 (median 11.3) for POPDI-6. The PASS cutoffs with (1) 75th percentile and (2) ROC curve method varied between 57.7–62.5 (median 60.0) for PFDI-20 and 16.7–17.7 (median 17.2) for POPDI-6. Conclusion: A mean difference of 24 points in the PFDI-20 or 11 points in the POPDI-6 can be used as a clinically relevant difference between groups. Postoperative scores ≤ 60 for PFDI-20 and ≤ 17 for POPDI-6 signify acceptable symptom state.

Original languageEnglish
Pages (from-to)3169–3176
JournalInternational Urogynecology Journal
Early online date2 Sep 2020
Publication statusPublished - 2021
Publication typeA1 Journal article-refereed


  • Minimal important difference
  • Patient-acceptable symptom state
  • Pelvic Floor Distress Inventory-20
  • Pelvic Organ Prolapse Distress Inventory-6
  • Pelvic organ prolapse surgery

Publication forum classification

  • Publication forum level 1


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