Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study

Abstract

BackgroundThe aims of the present study were first to detect MCID for WOMAC in a Moroccan population, and second, to identify the best pre-treatment predictors on the change of health after treatment by non-specific, non-steroidal anti-inflammatory drugs (NSAIDs), and to evaluate whether the predictors were dependent on the choice of the response criterion.MethodsThe study involved 173 patients with osteoarthritis in whom primary care physicians decided to start treatment with non-selective NSAIDs. Assessments at admission and after 6 weeks were conducted. In order to determine the threshold levels associated with a definition of clinically important improvement, the receiver operating characteristic method was used. Three different measures of response to a 6-week NSAIDs treatment were used: one indirect measure (MCID in the total WOMAC score), one direct measure (transition question) and a combination of both criteria.ResultsEighty patients (46.3%) reported "a slightly better" general health status compared to that of 6 weeks before NSAIDs treatment. The MCID proportion is a 16.0% reduction in WOMAC. The most stable pre-treatment predictors on the improvement of health after treatment by NSAIDs were the absence of previous knee injury and a high level of education.ConclusionsIn our data, a 16.0% reduction of the total WOMAC score from baseline was associated with the highest degree of improvement on the transition scale category. This cut-off point had good accuracy, and should be appropriate for use in the interpretation of clinical studies results, as well as in clinical care.

Prospective Randomized Trial of the Efficacy of Continuous Passive Motion Post Total Knee Arthroplasty: Experience of the Hospital for Special Surgery

“…This is consistent with what others have reported in the literature [1,2,5,7,8,18]. In this study, we found the group with the CPM to have a worse WOMAC score preoperatively, but the difference between the two groups is well below what has been established as the minimal clinically important difference [11]. No clinical important differences were found in WOMAC score.…”

A Feasibility Study of Percutaneous Peripheral Nerve Stimulation for the Treatment of Postoperative Pain Following Total Knee Arthroplasty

“…At two weeks following TKA, WOMAC scores improved by an average of 46% compared to before surgery, with five of seven subjects (71%) achieving a clinically significant improvement of ≥33%. By 12 weeks following surgery, the average improvement relative to before surgery was 85%, and all seven subjects (100%) had achieved clinically significant improvements in WOMAC .…”

Efficacy of Tai Chi on Pain, Stiffness and Function in Patients with Osteoarthritis: A Meta-Analysis

“…Changes of 20–25% in the WOMAC score are considered to be clinically relevant [35], but the most recent study suggested that a 16–18% reduction in the WOMAC score is associated with the MCID and should be appropriate for use in the interpretation of clinical studies, as well as in clinical care [36]. Our results indicate that a reduction of 32.2–36.4% from baseline was greater than the MCID of 16–18% or 20–25%, which suggests that TC has beneficial effects on pain, stiffness, and physical function in patients with knee OA.…”