Question 1

Why is imaging severity not the same as clinical severity?

Accepted Answer

Imaging shows structure, not symptoms, and they often diverge. Marked degenerative change can be painless, while a disabling problem can occur with a normal scan. Severity is therefore judged across separate domains, including symptoms, function and participation, examination and prognosis, with structural findings informing rather than defining it.

Question 2

What is the difference between the MDC and the MIC?

Accepted Answer

The minimal detectable change concerns measurement error: the smallest change beyond the error of the instrument. The minimal important change concerns meaning: the smallest within-person change a patient perceives as beneficial. They are not in a fixed order, so a change may matter to a patient yet still fall within measurement error.

Question 3

What does the patient acceptable symptom state (PASS) describe?

Accepted Answer

A final state rather than an amount of change: the threshold at which a patient considers themselves well enough. Depending on how the instrument is scored, the acceptable state may lie above or below the cut-off. A patient can improve meaningfully yet still not feel well enough, or reach an acceptable state without a large change.

Question 4

Which outcome measures count as clinician-reported?

Accepted Answer

Those that need a trained clinician's judgement to interpret an observable sign, such as rating the severity of a joint effusion or a neurological sign. Goniometric range of movement, dynamometry and hop tests are often misplaced here: they are performance outcomes, obtained when the patient completes a standardised, repeatable task.

Disease Severity and Outcome Measures

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