Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part I: Upper Extremity

Copay, Anne G.; Chung, Andrew S.; Eyberg, Blake A.; Olmscheid, Neil; Chutkan, Norman; Spangehl, Mark J.

doi:10.2106/jbjs.rvw.17.00159

Cited by 106 publications

(81 citation statements)

References 93 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with previous studies 23–25. A previous review of MIDs of upper extremity instruments that appeared in selected orthopaedic journals from 2014 to 2016 found a wide range of MIDs for the Constant score (8–36) and reported a pain VAS MID of 1.4 on 10-point scale 26. Reviews of pain VAS MIDs in shoulder injuries found a range of 0.5–3.0 24 36 46 47.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…13,15,36 However, as recent literature has emphasized, it is critical to use the MCID to judge the effectiveness of the treatment as perceived by the patients instead of just the P value to interpret the results. 8,18,21,25,38 Only 1 study has compared the improvement in postoperative function based on the MCID of the Flexilevel Scale of Shoulder Function (FLEX-SF) score and found it to be clinically significantly worse in the rRCR group than in the pRCR group. 15 In contrast, the patients in our study who had revision and primary surgery experienced similar pain relief and function in terms of clinically meaningful difference at the final follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we used MCID along with the statistical significance to compare the results between study groups, which is aligned with the recent emphasis on reporting the clinical significance of the observed difference in clinical outcomes. 8,18,21,25,38…”

Section: Discussionmentioning

confidence: 99%

Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes

Meshram

Liu

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The retear rate after revision rotator cuff repair (rRCR) ranges from 50% to 90%. Patients who undergo primary RCR (pRCR) for large to massive rotator cuff tear (mRCT) also have unpredictable outcomes. Purpose: To compare the clinical outcomes after rRCR for a posterosuperior rotator cuff tear of any size with those after pRCR for mRCT and to identify the risk factors for poor outcomes and retear after rRCR. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients with posterosuperior cuff tear treated between 2010 and 2017, the clinical outcomes of 46 patients who underwent rRCR were compared with 106 patients who underwent pRCR for mRCT. Between-group differences in patient-reported outcomes (visual analog scale [VAS] for pain, VAS for satisfaction and American Shoulder and Elbow Surgeons [ASES] and Constant scores) at final follow-up were evaluated and compared with previously published minimal clinically important difference (MCID) values. Radiological outcomes were evaluated using magnetic resonance imaging or ultrasonography at a minimum 1-year follow-up. Multivariate linear regression analysis was performed to identify the risk factors for poor ASES score, and multivariate logistic regression analysis was used to assess the risk factors for retear after rRCR. Results: The mean follow-up was 26.4 months (range, 24-81 months). Although final VAS for pain, VAS for satisfaction, and ASES scores in the rRCR group were significantly worse than those in the pRCR group, the Constant score was similar between the groups. These differences in outcomes did not exceed the MCID threshold. The retear rate in the rRCR group was 50% compared with 39% for the pRCR group ( P = .194). In the rRCR group, risk factors for worse ASES score were retear ( P = .043; r = –11.3), lower body mass index ( P = .032; r = 1.9), and lower preoperative VAS for pain ( P = .038; r = 2.3), and risk factors for retear were preoperative high-grade fatty degeneration (Goutallier grades 3 and 4) of the supraspinatus muscle ( P = .026; odds ratio, 5.2) and serum hyperlipidemia ( P = .035; odds ratio, 11.8). Conclusion: Both study groups had similar clinical and radiological outcomes. Patients with symptomatic failed rotator cuff repairs having high-grade fatty degeneration of the supraspinatus muscle and/or serum hyperlipidemia had a greater likelihood of retear after rRCR.

show abstract

“…2 To date, clinically significant outcome scores have not been established for PMR, which would serve as anchor points for predicted improvement after surgery. 6 Analysis of specific sports outcomes and weight-lifting outcomes offers a more comprehensive picture of expected postoperative outcome for this patient cohort, which has not been provided before in the literature.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

et al. 2019

View full text Add to dashboard Cite

Background: The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury. Hypothesis: A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score. Study Design: Case series; Level of evidence, 4. Methods: A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Results: Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores ( P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1–repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5–repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031). Conclusion: Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.

show abstract

Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part I: Upper Extremity

Abstract: The MCID is increasingly used as a measure of patients' improvement. However, the MCID does not yet adequately capture the clinical importance of patients' improvement.

Cited by 106 publications

References 93 publications

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

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

Revision Rotator Cuff Repair Versus Primary Repair for Large to Massive Tears Involving the Posterosuperior Cuff: Comparison of Clinical and Radiological Outcomes

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

Contact Info

Product

Resources

About