The Minimal Clinically Important Difference After Simple Decompression for Ulnar Neuropathy at the Elbow

Abstract

Purpose Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is an important component of outcomes research to understand treatment effectiveness from the patient’s perspective. For patients with ulnar neuropathy at the elbow (UNE), these assessments are vital to examine how much change in the questionnaire scores equate to patient satisfaction. Methods We calculated the change in scores of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Carpal Tunnel Questionnaire (CTQ) from preoperative to 3,6 and 12 months postoperatively after ulnar nerve simple decompression procedure. We used the anchor based approach of receiver operating characteristic curves to determine the MCID. Results On average, MCID of 10, 12, and 7 points were identified for pain, function, and ADL domains of MHQ. Similarly, DASH, CTQ-symptom severity scale, and CTQ-function severity scale had an average MCID of 7, 0.7, and 0.3 points respectively. At the 3, 6, and 12 months’ time-points, an MCID of 9, 8, and 13 points for pain, 12, 12, and 12 points for function, and 6, 8, and 6 points for ADL domains of the MHQ were identified; similarly an MCID of 8, 7, and 7 points for DASH; 0.4, 0.7, and 0.7 points for CTQ- symptom severity scale; and 0.3, 0.3, and 0.4 points for CTQ-function severity scale were established. Conclusion The smaller MCIDs of MHQ, DASH, and even smaller MCIDs of CTQ found in our study indicate that a small change in the scores identified satisfied patients. Simple decompression surgery for UNE produced patient satisfaction with only a small change in their questionnaire scores. The implications of this finding are that simple decompression surgery for UNE is a highly effective procedure and the outcomes questionnaires used are highly responsive, which minimizes sample size requirements for future research studies relating to UNE.

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

“…The level of significance was set at p\0.05. To demonstrate the effectiveness of a treatment, a minimal clinically important difference in VAS scores for pain has been reported ranging from 0.9 to 1.4 [9,19,28] and, in DASH score, ranging from 7 to 13.5 [11,20,21]. However, other measurements do not have the reported minimal clinically significant differences.…”

Outcome of simple decompression of the compressed ulnar nerve at the elbow – influence of smoking, gender, and electrophysiological findings

“…QuickDASH is a questionnaire, which the patients fill in before and at one year after surgery. At that time it is considered that the healing process is finished and all temporary side effects has even out [6,15]. QuickDASH consists of 11 items in which the patients rank their problems on a scale from 1 to 5.…”

“…Furthermore, a postoperative total score of more than 10 is valued as having persistent problems [17]. 6 Patients were excluded from the study if they had not filled in the postoperative QuickDASH or if the surgery was a revision on the same arm ( Figure 1). Also, patients who were operated on as a primary procedure with submuscular or subcutaneous transposition were excluded …”

“…Several instruments has been used to simply assess outcome in clinical practice, such as the Michigan Hand Outcomes Questionnaire (MHQ), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Carpal Tunnel Questionnaire (CTQ), and recently a new one was introduced; PRUNE [6,7]. Interestingly, evaluation of a minimally clinically important difference for these patient-reported outcome questionnaires signifies that small score differences in MHQ and DASH, as well as an even smaller difference in CTQ, after simple ulnar nerve decompression identified satisfied patients; thus, such outcome questionnaires are highly responsive in relation to surgery for ulnar nerve compression [6].…”

“…Interestingly, evaluation of a minimally clinically important difference for these patient-reported outcome questionnaires signifies that small score differences in MHQ and DASH, as well as an even smaller difference in CTQ, after simple ulnar nerve decompression identified satisfied patients; thus, such outcome questionnaires are highly responsive in relation to surgery for ulnar nerve compression [6]. Furthermore, it has been pointed out that smaller sample sizes can be used when such questionnaires are utilized to evaluate outcome up to 12 months post surgery in ulnar nerve compression [6].…”