Minimal Clinically Important Differences of 3 Patient-Rated Outcomes Instruments

Abstract

Purpose Patient-rated instruments are increasingly used to measure orthopaedic outcomes. However, the clinical relevance of modest score changes on such instruments is often unclear. This study was designed to define the minimal clinically important differences (MCID) of the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, and Patient Rated Wrist Evaluation (PRWE) for atraumatic conditions of the hand, wrist, and forearm. Methods One hundred two patients undergoing nonoperative treatment for isolated tendonitis, arthritis, or nerve compression syndromes from the forearm to the hand were analyzed prospectively. Patients completed the DASH, Quick DASH (subset of DASH), and PRWE at enrollment, 2 weeks (n=78 used in analysis), and 4 weeks (n=24 used in analysis) after initiating treatment by telephone. Patients reporting clinical improvement each contributed a single data point categorized as no change (n=41), minimal improvement (n=30), or marked improvement (n=31) via a validated anchor-based approach. The minimal clinically important difference was calculated as the mean change score for each outcome measure in the minimal improvement group. Results The MCID (95%CI) for the DASH was 10 (5-15). The MCID for the Quick DASH was 14 (9-20). The MCID was 14 (8-20) for the PRWE. MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement. MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores. Discussion Longitudinal changes on the DASH of 10 points, the Quick DASH of 14 points, and the PRWE of 14 points represent minimal clinically important changes. We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients. These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures. Level of Evidence: Diagnostic III

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

“…In the current study, HISS was associated with a decrease in QuickDASH scores up to a 6-month followup. However, statistically significant differences in outcome scores are not necessarily clinically important [21] and further analysis accounting for a minimal clinical important difference of the outcome instrument may be needed to determine whether significant associations (effects) are clinically important when making treatment decisions.…”

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

“…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.…”

“…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. 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.…”

Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis: Early Outcomes from a Longitudinal Cohort Study

“…We obtained validated patient related questionnaires in all enrolled patients to assess disability including QuickDASH, Michigan Hand Questionnaire (MHQ), Visual Analog Pain (VAS-pain), and EQ-5D-3L overall health status scores postoperatively. The study was powered to detect a minimal clinically important difference (MCID) of 14 on the QuickDASH questionnaire between the treatment groups [25]. Physical examination outcome data were also collected.…”