Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform aBMJRapid Recommendation

Abstract

ObjectivesTo identify credible anchor-based minimal important differences (MIDs) for patient-reported outcome measures (PROMs) relevant to aBMJRapid Recommendations addressing subacromial decompression surgery for shoulder pain.DesignSystematic review.Outcome measuresEstimates of anchor-based MIDs, and their credibility, for PROMs judged by the parallelBMJRapid Recommendations panel as important for informing their recommendation (pain, function and health-related quality of life (HRQoL)).Data sourcesMEDLINE, EMBASE and PsycINFO up to August 2018.Study selection and review methodsWe included original studies of any intervention for shoulder conditions reporting estimates of anchor-based MIDs for relevant PROMs. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria. Six reviewers, working in pairs, independently extracted data from eligible studies using a predesigned, standardised, pilot-tested extraction form and independently assessed the credibility of included studies using an MID credibility tool.ResultsWe identified 22 studies involving 5562 patients that reported 74 empirically estimated anchor-based MIDs for 10 candidate instruments to assess shoulder pain, function and HRQoL. We identified MIDs of high credibility for pain and function outcomes and of low credibility for HRQoL. We offered median estimates for the systematic review team who applied these MIDs in Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence summaries and in their interpretations of results in the linked systematic review addressing the effectiveness of surgery for shoulder pain.ConclusionsOur review provides anchor-based MID estimates, as well as a rating of their credibility, for PROMs for patients with shoulder conditions. The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain, and could also prove useful for authors addressing other interventions for shoulder problems.PROSPERO registration numberCRD42018106531.

Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study

“…We have not established the validity of our instrument by formal testing. In other work, however, we have shown that the current criteria for credibility succeed in partially explaining the variability in the magnitude of the MID 2993. Our instrument does not deal with the underlying measurement properties of the patient reported outcome measures (that is, validity and responsiveness) and assumes that users will only move forward in evaluating the credibility of MIDs if the instrument has met at least minimal standards of validity and responsiveness.…”

“…In developing our inventory of anchor based MIDs, and in other related work,2993 we found that the literature often includes a number of candidate MIDs for the same patient reported outcome measure. Moreover, the magnitude of these estimates sometimes varies widely.…”

Effect of A Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

“…However, a significant reduction (4 vs. 1, 30% drop form baseline) in pain intensity was observed only in the NS group, while the traditional MSS group remained essentially stable. A 30-35% reduction in pain from baseline or a decrease of 1.5 to 1.6 on a 10-point NPRS can be considered significant and was rated as MCID (believed to be meaningful by the patients) (42)(43)(44). Previous research showed symptoms (pain) relief after stretching program in athletes with GIRD and impingement-related shoulder pain (45).…”

Effect of a Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

“…However, a signi cant reduction (4 vs. 1, 30% drop form baseline) in pain intensity was observed only in the NS group, while the traditional MSS group remained essentially stable. A 30-35% reduction in pain from baseline or a decrease of 1.5 to 1.6 on a 10point NPRS can be considered signi cant and was rated as MCID (believed to be meaningful by the patients) (42)(43)(44). Previous research showed symptoms (pain) relief after stretching program in athletes with GIRD and impingement-related shoulder pain (45).…”