Minimal important changes and differences in elective hand surgery

Rodrigues, Jeremy; Mabvuure, Nigel Tapiwa; Nikkhah, Dariush; Shariff, Zakir; Davis, T. R. C.

doi:10.1177/1753193414553908

Cited by 52 publications

(49 citation statements)

References 52 publications

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“…Finally, we calculated differences between the highest quality and lowest quality groups in predicted outcomes, along with 95% confidence intervals (CIs). In a priori power calculations, we anticipated having 80% power to detect a 0.46‐point difference in the ΔBCTQ‐SS 34 …”

Section: Methodsmentioning

confidence: 99%

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

et al. 2020

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Introduction The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health‐care expenditures. Methods We evaluated test quality among 338 adults with workers’ compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12‐item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. Results In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (−0.50 point; 95% confidence interval [CI], −0.89 to −0.12) and functional impairment (−0.42 point; 95% CI, −0.78 to −0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. Discussion Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.

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Section: Methodsmentioning

confidence: 99%

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

et al. 2020

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“…According to a systematic review of changes in outcomes following hand surgery, minimal important differences ranged from 0.16 to 1.85 for the BCTQ-SS. 41 In comparison, when patients with classic/probable CTS and positive electrodiagnostic test results received better care, they experienced 0.25-point greater improvement in BCTQ-SS scores.…”

Section: Discussionmentioning

confidence: 96%

“…Effect sizes in the main analyses of underuse and overuse were generally small (0.15–0.21 for statistically significant findings), and changes in BCTQ‐SS scores were similar to or smaller than the smallest changes in treatment outcomes that patients have considered important (minimal important differences) in prior studies. According to a systematic review of changes in outcomes following hand surgery, minimal important differences ranged from 0.16 to 1.85 for the BCTQ‐SS . In comparison, when patients with classic/probable CTS and positive electrodiagnostic test results received better care, they experienced 0.25‐point greater improvement in BCTQ‐SS scores.…”

Section: Discussionmentioning

confidence: 99%

Quality of care and patient‐reported outcomes in carpal tunnel syndrome: A prospective observational study

et al. 2018

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“…Participants' opinions of the PROMs were used to guide the choice of which to use as the primary outcome in a future definitive trial. We planned to estimate the MCID and responsiveness using effect size for each of the four PROMs using the GRC as the "anchor" [17]. However, neither was possible because an insufficient number of participants (n = 7) reported feeling a "little better" on the GRC.…”

Section: Methodsmentioning

confidence: 99%

A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren’s contractures

Davis

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Hollingworth

et al. 2020

Pilot Feasibility Stud

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and the HAND-1 Study groupAbstract Purpose: The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren's contractures. Design: The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. Participants: Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren's contractures of one or more fingers of more than 30°at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren's contracture surgery on the same hand.Methods: Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. Results: One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren's contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. Conclusion: A large RCT comparing treatment of Dupuytren's contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren's contractures. (Level 1 feasibility study).Trial registration: Trial registered with ISRCTN (registration number: ISRCTN11164292), date assigned -28/08/2015.

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Minimal important changes and differences in elective hand surgery

Abstract: II.

Cited by 52 publications

References 52 publications

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures

Quality of care and patient‐reported outcomes in carpal tunnel syndrome: A prospective observational study

A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren’s contractures

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