Patient Global Impression of Change PGIC
Patient Global Impression of Change PGIC overview
Creator and Context
The Patient Global Impression of Change (PGIC) is a single item measure asking the person how much their condition has changed since treatment began.
It descends from the Clinical Global Impression family published in the NIMH ECDEU Assessment Manual in 1976. It has no single modern author: it is a family of near identical single item global change ratings, and it is the standard anchor used to interpret whether a change on any other measure was meaningful to the patient.
Presenting Conditions
The PGIC captures the person's own global judgement of change across their overall status: symptoms, activity limitations, emotions and quality of life, taken together.
It is a single item with no subscales.
Administration
Self administered in under a minute, at follow up or at the end of treatment. The person selects one of seven ordered categories, ranging from very much improved through no change to very much worse.
The recall anchor is explicitly since treatment began.
Desired Audience
Any patient, any condition, any age with the reading comprehension to answer it. It is used most heavily in pain, musculoskeletal care and psychopharmacology.
A four point drop on a symptom scale is a statistic. The PGIC tells you whether the person actually noticed. That is why it is the reference anchor for judging clinical importance, and why one question is often worth more than twenty.
Considerations
Version fragmentation is the biggest risk. Wording, polarity and anchors differ across published variants, and scores are not comparable across versions. Pin one version and state which.
Polarity varies. In some versions lower means more improved, in others the reverse. Always label the scale explicitly.
It is a retrospective global judgement and is known to be coloured by how the person feels today rather than by true change. It does not replace pre and post measurement.
The widely quoted 30 percent or two point correspondence is specific to pain intensity on a numerical rating scale. It does not transfer to mental health measures.
How to score the Patient Global Impression of Change PGIC
Conducting the assessment
The person selects one of seven ordered categories describing their overall status since treatment began.
Interpretation
A single ordinal score from 1 to 7.
The standard responder definition is a rating of much improved or very much improved, which is taken to indicate clinically important improvement.
In chronic pain, Farrar et al. (2001) found across ten trials and 2,724 patients that a reduction of about 2 points, or about 30 percent, on a 0 to 10 pain rating corresponded to a patient rating of much improved. That correspondence is specific to pain intensity and should not be carried across to other measures.
Clinical Considerations
Use it alongside a symptom measure, not instead of one. Where the two disagree, that disagreement is worth exploring in the room.
State the version and the polarity wherever the score is displayed.
Treat much improved or very much improved as the responder definition.
Patient Global Impression of Change PGIC use cases
Capturing the person's own judgement of whether treatment helped
Anchoring the interpretation of change scores on other measures
Defining treatment responders in trials and in service reporting
Brief outcome capture where a full measure is impractical
Category
Feedback
Research Summary
Guy, W. (Ed.). (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: US Department of Health, Education, and Welfare.
Farrar, J. T., Young, J. P., LaMoreaux, L., Werth, J. L., & Poole, R. M. (2001). Clinical importance of changes in chronic pain intensity measured on an 11 point numerical pain rating scale. Pain, 94(2), 149 to 158.
Dworkin, R. H., Turk, D. C., Wyrwich, K. W., et al. (2008). Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain, 9(2), 105 to 121.
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