Defining MCID in patients following meniscectomy and the role of pre-operative PROMIS scores in predicting clinical improvement

Abstract

Objectives: The Patient-Reported Outcomes Measurement Information System (PROMIS) is emerging as a valid and efficient means of collecting patient outcomes in patients with meniscal tears. Our purpose was to examine the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting post-operative PROMIS CAT scores, as well as the minimal clinically important difference (MCID) following meniscectomy. We hypothesize that pre-operative PROMIS CAT scores will directly impact both post-operative PROMIS CAT scores and likelihood of achieving MCID. Methods: Patients undergoing arthroscopic meniscectomy that completed PROMIS CAT forms for physical function (PROMIS-PF), pain interference (PROMIS-PI), and depression (PROMIS-D) were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Preoperative cutoffs were used to predict which patients would likely meet MCID, using 90% specificity. Results: A total of 135 patients met our inclusion criteria. PROMIS-PF, PROMIS-PI, and PROMIS-D improved 3 months after surgery (p<0.01). 62% of the entire cohort met MCID for PROMIS-PF, while 68% met MCID for PROMIS-PI, and 41% met MCID for PROMIS-D. Individuals with PROMIS-PF scores below 34.9 yielded an 82% probability of achieving MCID, while PROMIS-PI scores above 67.5 yielded an 86% probability of achieving MCID and a cutoff of 58.9 for PROMIS-D yielded a 60% probability of achieving MCID, with 90% specificity. Conclusions: Significant portions of patients undergoing meniscectomy achieve MCID in PROMIS-PF, PROMIS-PI, and PROMIS-D, at the 3-month time point. In particular, patients with PROMIS-PF scores of <34.9 are far more likely to achieve MCID for physical function.

Approximately One Half of Patients Greater Than 40 Years Old Achieve Patient Acceptable Symptomatic State 6 Months After Arthroscopic Partial Meniscectomy

“…Second, the MCID results are similar to many studies of APM and knee arthroscopy. 1 , 3 , 15 , 17 , 25 , 26 KOOS subscore MCID values ranged from 8.5 to 15.6 in Gowd et al.’s work, 3 and 12.5-17.5 for Kenney et al. 26 MCIDs in the current study ranged from 8.8 to 11.8.…”

“… 21 , 22 , 23 Their results represent a similar disconnect between patients who improved in a statistically measurable amount and those who were satisfied with this improvement. For APM, ∼60-70% meet MCID for functional and pain scores 17 , 25 and in a separate study, 67% achieve PASS. 3 However, these and other APM outcomes studies have been limited by use of a single, binary PASS question and a lack of directed queries regarding TF.…”

PROMIS physical function and pain perform poorly psychometrically in patients undergoing medial patellofemoral ligament reconstruction

“…This system provides an adaptable question set that can be used for a variety of orthopaedic conditions, generating faster response time and decreasing question burden. PROMIS has been used for evaluating clinical thresholds such as minimal clinically important difference in rotator cuff repair [23] and meniscectomy[14], and in predicting postoperative outcomes after anterior cruciate ligament (ACL) reconstruction surgery[1, 9]. Numerous studies comparing PROMIS to legacy PROs for a variety of orthopaedic conditions, ranging from ACL reconstruction to upper extremity fractures [9, 16, 17, 29, 36, 42, 43], have reported high levels of validity and responsiveness for PROMIS [9].…”