Measurement:

Sensitivity to Change

David Luckenbaugh
Statistician
Equity, Diversity, and Inclusion
Office of the Director
National Institutes Health
OBJECTIVE
Enhance understanding of key principles
of sensitivity to change as relevant for
clinical research
Examples
1. Depression
A. Hamilton Depression Rating Scale
B. Beck Depression Inventory

2. Tremor
A. Judge rated spirals
B. Computer evaluated spirals

3. Heart Disease
A. Cholesterol
B. C-Reactive Protein
SENSITIVITY to CHANGE
Ability to detect improvement or worsening
SENSITIVITY to CHANGE
Can assess with effect size

Cohen’s d = (Mean2 – Mean1)/SD

• StandardInterpretation
.8 Large
.5 Moderate
.2 Small
SENSITIVITY to CHANGE
Carbamazepine vs. Lithium
1

0.8
Effect Size (d)

0.6

0.4

0.2

0
Episodes YMRS Time Ill Mean
Severity

Denicoff, et al., J Clin Psychi, 1997

SENSITIVITY to CHANGE
Carbamazepine vs. Lithium
450
Minimum Total Sample Size

400
350
300
250
200
150
100
50
0
Episodes YMRS Time Ill Mean Severity

Denicoff, et al., J Clin Psychi, 1997

SENSITIVITY to CHANGE: Summary
1. Sensitivity to change is the ability to
detect movement in a measure

2. Sensitivity to change can be measured

with effect sizes

3. Sensitivity to change can alter the

sample size needed to conduct a study
SENSITIVITY to CHANGE: Questions
1. What can be used to measure sensitivity
to change?

2. When planning the number of

participants in a study, do you need to
worry about sensitivity to change?