Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH)

“…9,27 After triangulation of all our results, for the DASH, a change of 10.83 points was defined as the most acceptable MCID for moderate improvement, with good sensitivity (82%), specificity (74%), and classification accuracy (79%). 10 This MCID was inside the 95% CI for our ROC cutoff values, slightly superior to both our MDC 90 (10.8 points) and the MDC 95 (10.7 points) reported by Beaton et al, 3 and in line with the MCID (10 points; 95% CI: 5, 15) calculated in a sample of patients undergoing nonoperative treatment for forearm, wrist, and Various authors have suggested that it would be better to define a range of MCID values rather than a fixed value, 10,11 and there are reasons to be skeptical about claims of a single MCID value. 24 Overall, due to our methodological procedure, with its main focus on the ROCcurve approach and an MCID value higher than MDC 90 and not MDC 95 , our threshold of 10.83 points could represent the lower boundary for a small range of reasonable MCIDs, in which the upper boundary could be represented by the 15 points proposed by the DASH website, 20 according to Beaton et al, 2 who just considered the AUC in ROC curves for score changes of -1, -5, -7, -10, -15, and -20.…”

“…9 In addition, different criteria have been used to calculate and select both ROC cutoff values and MCIDs in DASH and QuickDASH studies. 2,3,9,25,27,36 Finally, the alternate use of raw scores 25 and 0-to-100 converted scores (rounded or not) represents a further potential source of confusion. Overall, any direct comparison of MCIDs is difficult, due to methodological issues that include type of anchor, calculation procedures, decision rules, and so on.…”

“…Strengths and weaknesses of the DASH and Quick-DASH have been well investigated by both classical test theory 1,23 and Rasch analysis, 12,13 but many different approaches have been used to calculate the responsiveness of these measures, in particular the minimal clinically important difference (MCID), also known as the minimal important change, which focuses on within-person change over time. 3,21 The MCID represents the smallest improvement in score to reflect a change that is clinically meaningful for the patient. 17 The MCID threshold is very important in daily practice, where clinicians routinely compare, at the individual level, the current and previous values of outcome measures of interest.…”

“…40 However, the studies calculating MCID through anchor-based approaches are limited for both the DASH 2,3,9,24,25,35,36 and QuickDASH. 24,27,30,36 In addition, it appears that the best choice to determine MCID is to select a small range of threshold estimates after comparing and interpreting the information conveyed by multiple reference standards, calculated on the same sample.…”

“…24,27,30,36 In addition, it appears that the best choice to determine MCID is to select a small range of threshold estimates after comparing and interpreting the information conveyed by multiple reference standards, calculated on the same sample. 32,39,40 To date, such an approach has only recently been applied for the DASH in a study 3 dealing with soft tissue shoulder disorders. Therefore, further investigation of these outcome measures is needed to establish the stability of prior reports and to investigate MCID values in other cohorts, so as to provide useful insights about the magnitude of change in score that could be considered a clinically meaningful improvement.…”