Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale© in the monitoring of multifocal motor neuropathy

Yusuf Rajabally; Ahmad Al-Areed; Roshan  Iqbal; Muhammed A. Noushad; Young G. Min; Chinar Osman

doi:10.1007/s00415-026-13771-8

Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale© in the monitoring of multifocal motor neuropathy

Yusuf Rajabally
, Ahmad Al-Areed
, Roshan Iqbal
, Muhammed A. Noushad
, Young G. Min
, Chinar Osman

College of Health and Life Sciences

University Hospital Southampton
Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
Yonsei University College of Medicine

Research output: Contribution to journal › Article › peer-review

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Abstract

Background:
Optimal clinical application of the minimal clinically important difference (MCID) for the MMN-Rasch-built Overall Disability Scale© (MMN-RODS) scale is unknown.

Methods:
We retrospectively studied subjects with MMN from 2 UK neuropathy centres. Raw and centile MMN-RODS scores were collected, at initial, two intermediate, and latest assessment, and distribution-based MCIDs determined at studied time-points. The sensitivities of raw, centile and individualised MCIDs, were compared.

Results:
We included 32 consecutive subjects with MMN on individualised immunoglobulin dosing regimens. First intermediate, second intermediate, and latest assessments were performed at a median of 17.0, 54.1 and 74.6 months from onset, respectively. Progressive amelioration of mean raw MMN-RODS score occurred between initial and latest assessment. The distribution-based raw MMN-RODS MCID was of 3, 4 and 5, and the distribution-based centile MMN-RODS MCID was of 6, 7 and 7, at first intermediate, second intermediate and latest assessment, respectively. At first intermediate assessment, raw and individualised MCIDs were equally sensitive, and both more sensitive than centile MCID (McNemar’s Test: p < 0.001, p < 0.001). Raw MCID, centile MCID and individualised MCID, all had equivalent sensitivity at the second intermediate and latest assessment. Neither initial MMN-RODS score, nor amplitude of treatment-induced changes in early disease stages, independently predicted total improvement amplitude or final outcome.

Conclusions:
MMN-RODS MCID cut-offs may require adaption to assessment timing. In earlier stages, raw/individualised MCID may be more sensitive than centile MCID, whereas all three methods may subsequently be equivalent. Initial disability and early treatment response do not predict achievable total improvement amplitude nor final outcome.

Original language	English
Article number	289
Number of pages	8
Journal	Journal of Neurology
Volume	273
Issue number	5
Early online date	26 Apr 2026
DOIs	https://doi.org/10.1007/s00415-026-13771-8
Publication status	Published - 1 May 2026

Bibliographical note

Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

Funding

We are grateful to Prof. Karin Faber, Maastricht University, Netherlands, for kindly providing the algorithm for centile transformation of raw MMN-RODS scores as well as the individualised MCID cut-offs. We thank Ms. Jade Donnelly, Neurophysiotherapy Department, University Hospital Southampton, for her help in collecting the outcome measures reported in this study for patients from Southampton, UK.

Keywords

Centile
Individualised
MMN-RODS
Minimal clinically important difference
Multifocal motor neuropathy
Outcomes
Raw

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10.1007/s00415-026-13771-8Licence: CC BY 4.0

Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale© in the monitoring of multifocal motor neuropathy
Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
Final published version, 725 KBLicence: CC BY 4.0

Cite this

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title = "Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale{\textcopyright} in the monitoring of multifocal motor neuropathy",

abstract = "Background: Optimal clinical application of the minimal clinically important difference (MCID) for the MMN-Rasch-built Overall Disability Scale{\textcopyright} (MMN-RODS) scale is unknown. Methods: We retrospectively studied subjects with MMN from 2 UK neuropathy centres. Raw and centile MMN-RODS scores were collected, at initial, two intermediate, and latest assessment, and distribution-based MCIDs determined at studied time-points. The sensitivities of raw, centile and individualised MCIDs, were compared. Results: We included 32 consecutive subjects with MMN on individualised immunoglobulin dosing regimens. First intermediate, second intermediate, and latest assessments were performed at a median of 17.0, 54.1 and 74.6 months from onset, respectively. Progressive amelioration of mean raw MMN-RODS score occurred between initial and latest assessment. The distribution-based raw MMN-RODS MCID was of 3, 4 and 5, and the distribution-based centile MMN-RODS MCID was of 6, 7 and 7, at first intermediate, second intermediate and latest assessment, respectively. At first intermediate assessment, raw and individualised MCIDs were equally sensitive, and both more sensitive than centile MCID (McNemar{\textquoteright}s Test: p < 0.001, p < 0.001). Raw MCID, centile MCID and individualised MCID, all had equivalent sensitivity at the second intermediate and latest assessment. Neither initial MMN-RODS score, nor amplitude of treatment-induced changes in early disease stages, independently predicted total improvement amplitude or final outcome. Conclusions: MMN-RODS MCID cut-offs may require adaption to assessment timing. In earlier stages, raw/individualised MCID may be more sensitive than centile MCID, whereas all three methods may subsequently be equivalent. Initial disability and early treatment response do not predict achievable total improvement amplitude nor final outcome.",

keywords = "Centile, Individualised, MMN-RODS, Minimal clinically important difference, Multifocal motor neuropathy, Outcomes, Raw",

author = "Yusuf Rajabally and Ahmad Al-Areed and Roshan Iqbal and Noushad, \{Muhammed A.\} and Min, \{Young G.\} and Chinar Osman",

note = "Copyright {\textcopyright} The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/. ",

year = "2026",

month = may,

day = "1",

doi = "10.1007/s00415-026-13771-8",

language = "English",

volume = "273",

journal = "Journal of Neurology",

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TY - JOUR

T1 - Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale© in the monitoring of multifocal motor neuropathy

AU - Rajabally, Yusuf

AU - Al-Areed, Ahmad

AU - Iqbal , Roshan

AU - Noushad, Muhammed A.

AU - Min, Young G.

AU - Osman, Chinar

N1 - Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

PY - 2026/5/1

Y1 - 2026/5/1

N2 - Background: Optimal clinical application of the minimal clinically important difference (MCID) for the MMN-Rasch-built Overall Disability Scale© (MMN-RODS) scale is unknown. Methods: We retrospectively studied subjects with MMN from 2 UK neuropathy centres. Raw and centile MMN-RODS scores were collected, at initial, two intermediate, and latest assessment, and distribution-based MCIDs determined at studied time-points. The sensitivities of raw, centile and individualised MCIDs, were compared. Results: We included 32 consecutive subjects with MMN on individualised immunoglobulin dosing regimens. First intermediate, second intermediate, and latest assessments were performed at a median of 17.0, 54.1 and 74.6 months from onset, respectively. Progressive amelioration of mean raw MMN-RODS score occurred between initial and latest assessment. The distribution-based raw MMN-RODS MCID was of 3, 4 and 5, and the distribution-based centile MMN-RODS MCID was of 6, 7 and 7, at first intermediate, second intermediate and latest assessment, respectively. At first intermediate assessment, raw and individualised MCIDs were equally sensitive, and both more sensitive than centile MCID (McNemar’s Test: p < 0.001, p < 0.001). Raw MCID, centile MCID and individualised MCID, all had equivalent sensitivity at the second intermediate and latest assessment. Neither initial MMN-RODS score, nor amplitude of treatment-induced changes in early disease stages, independently predicted total improvement amplitude or final outcome. Conclusions: MMN-RODS MCID cut-offs may require adaption to assessment timing. In earlier stages, raw/individualised MCID may be more sensitive than centile MCID, whereas all three methods may subsequently be equivalent. Initial disability and early treatment response do not predict achievable total improvement amplitude nor final outcome.

AB - Background: Optimal clinical application of the minimal clinically important difference (MCID) for the MMN-Rasch-built Overall Disability Scale© (MMN-RODS) scale is unknown. Methods: We retrospectively studied subjects with MMN from 2 UK neuropathy centres. Raw and centile MMN-RODS scores were collected, at initial, two intermediate, and latest assessment, and distribution-based MCIDs determined at studied time-points. The sensitivities of raw, centile and individualised MCIDs, were compared. Results: We included 32 consecutive subjects with MMN on individualised immunoglobulin dosing regimens. First intermediate, second intermediate, and latest assessments were performed at a median of 17.0, 54.1 and 74.6 months from onset, respectively. Progressive amelioration of mean raw MMN-RODS score occurred between initial and latest assessment. The distribution-based raw MMN-RODS MCID was of 3, 4 and 5, and the distribution-based centile MMN-RODS MCID was of 6, 7 and 7, at first intermediate, second intermediate and latest assessment, respectively. At first intermediate assessment, raw and individualised MCIDs were equally sensitive, and both more sensitive than centile MCID (McNemar’s Test: p < 0.001, p < 0.001). Raw MCID, centile MCID and individualised MCID, all had equivalent sensitivity at the second intermediate and latest assessment. Neither initial MMN-RODS score, nor amplitude of treatment-induced changes in early disease stages, independently predicted total improvement amplitude or final outcome. Conclusions: MMN-RODS MCID cut-offs may require adaption to assessment timing. In earlier stages, raw/individualised MCID may be more sensitive than centile MCID, whereas all three methods may subsequently be equivalent. Initial disability and early treatment response do not predict achievable total improvement amplitude nor final outcome.

KW - Centile

KW - Individualised

KW - MMN-RODS

KW - Minimal clinically important difference

KW - Multifocal motor neuropathy

KW - Outcomes

KW - Raw

UR - https://link.springer.com/article/10.1007/s00415-026-13771-8

UR - https://www.scopus.com/pages/publications/105036872307

U2 - 10.1007/s00415-026-13771-8

DO - 10.1007/s00415-026-13771-8

M3 - Article

C2 - 42036503

SN - 0340-5354

VL - 273

JO - Journal of Neurology

JF - Journal of Neurology

IS - 5

M1 - 289

ER -

Raw, centile and individualised minimal clinically important differences for the MMN-Rasch-built Overall Disability Scale© in the monitoring of multifocal motor neuropathy

Abstract

Bibliographical note

Funding

Keywords

Access to Document

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