Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12

Abstract

Introduction: Minimal important difference (MID) score is an important measure for surgical clinical research and impacts on treatment decisions. Our approach considered patient satisfaction as the relevant anchor criteria. The aims of this study were: determine after surgery MID for three relevant questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Questionnaire (MHQ), and Short Form 12 (SF-12); and assess the correlation between these scores and patient reported satisfaction. Methods: Adult patients where surgery was indicated for any hand/wrist conditions. Study was conducted in a teaching hospital, São Paulo, Brazil. Participants responded to DASH, SF-12, MHQ, and a Likert satisfaction scale before and three months after a procedure. Satisfaction was considered as the anchor for determining MID after a procedure. The correlation between satisfaction and the instruments were measured. Two statistical approaches were utilized for determining MIDs and were used for consistency and generalizability purposes. For MID determination, receiver operating curves were utilized and MID cut-offs were followed by sensitivity and specificity measures. Results: Fifty patients were included with no follow-up losses. MID for DASH was 18.8 and 15.4. MID for MHQ was 14.7 for both approaches. Data from SF-12 was not reliable after statistical analyses and demonstrated poor correlation with patient satisfaction. MID for DASH and MHQ were found and demonstrated larger standards than literature-reported patients when surgery was not the main intervention. DASH and MHQ had moderate correlation with patient reported satisfaction. SF-12 MID was not reliable and had poor correlation to patient satisfaction. These data suggests that ambulatory hand surgery patients may have greater expectations regarding improvement than other patients.

Clinical thresholds of symptoms for deciding on surgery for trapeziometacarpal osteoarthritis

“…These values are similar to our MIC of 16. In contrast, MIC thresholds for the brief and original MHQ total score range from 7 to 15 for patients with various hand disorders (London et al., 2014; Maia et al., 2016; Rodrigues et al., 2015, 2017; Wehrli et al., 2016). Our higher value can be explained by the varied effectiveness of TMC surgery, which presumably provides greater symptom relief in patients with worse baseline symptoms than in the aforementioned studies.…”

“…Changes exceeding this value can be considered relevant for the patient. Several studies have investigated MIC for various outcome measures in hand surgery (London et al., 2014; Maia et al., 2016; Marti et al., 2016; Marks et al, 2019; Rodrigues et al., 2015, 2017; Shauver and Chung, 2009; Wehrli et al., 2016). For patients with trapeziometacarpal (TMC) osteoarthritis (OA), however, the MIC has only been determined for the Michigan Hand Outcomes Questionnaire (MHQ, Marks et al., 2014).…”

Structural validity and construct validity of the Dutch-Flemish PROMIS® physical function-upper extremity version 2.0 item bank in Dutch patients with upper extremity injuries

“…Higher scores indicate less disability. Both the primary English MHQ and the official Dutch translation have good psychometric properties [8,[33][34][35][36][37][38].…”

Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction

“…The finding that SF-12 physical and mental component scores were not related to changes in the other patient-rated scores is not unique to our study. Maia et al 22 also noted this in relation to upper extremity conditions and suggested that the SF-12 is too broad in its assessment of individuals to pick up changes where region or diseasespecific changes are being assessed.…”