Threshold Values for Success After Hip Arthroscopy Using the Patient-Reported Outcomes Measurement Information System Assessment: Determining the Minimum Clinically Important Difference and Patient Acceptable Symptomatic State

Abstract

Background: Threshold values for patient-reported outcome measures, such as the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS), are important for relating postoperative outcomes to meaningful functional improvement. Purpose: To determine the PASS and MCID after hip arthroscopy for femoroacetabular impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A consecutive series of patients undergoing primary hip arthroscopy for femoroacetabular impingement were administered preoperative and minimum 1-year postoperative PROMIS surveys focusing on physical function (PF) and pain interference (PI). External anchor questions for the MCID and PASS were given with the postoperative PROMIS survey. Receiver operator curves were constructed to determine the threshold values for the MCID and PASS. Curves were generated for the study population as well as separate cohorts segregated by median baseline PF or PI scores and preoperative athletic participation. A multivariate post hoc analysis was then constructed to evaluate factors associated with achieving the PASS or MCID. Results: There were 113 patients (35% male; mean ± SD age, 32.8 ± 12.5 years; body mass index, 25.8 ± 4.8 kg/m2), with 60 (53%) reporting preoperative athletic participation. Survey time averaged 77.5 ± 49.2 seconds. Anchor-based MCID values were 5.1 and 10.9 for the PF and PI domains, respectively. PASS thresholds were 51.8 and 51.9 for the PF and PI, respectively. PASS values were not affected by baseline scores, but athletic patients had a higher PASS threshold than did those not participating in a sport (53.1 vs 44.7). MCID values were affected by preoperative baseline scores but were largely independent of sports participation. A post hoc analysis found that 94 (83%) patients attained the MCID PF while 66 (58%) attained the PASS PF. A multivariate nominal logistic regression found that younger patients ( P = .01) and athletic patients ( P = .003) were more likely to attain the PASS. Conclusion: The PROMIS survey is an efficient metric to evaluate preoperative disability and postoperative function after primary hip arthroscopy for femoroacetabular impingement. The MCID and PASS provide surgeons with threshold values to help determine PROMIS scores that are clinically meaningful to patients, and they can assist with therapeutic decision making as well as expectation setting.

Minimal important differences and self‐identifying treatment response in chronic inflammatory demyelinating polyneuropathy

“…Previous studies have, with relevant outcome measures for CIDP such as grip strength, 2-minute walk test, or Timed Up and Go test, attempted to determine the MDC in limited numbers of subjects with type 2 diabetes 12 and total hip arthroplasty. 13 MID has similarly been evaluated in subjects with diverse conditions such as after hip arthroplasty 14 or chronic obstructive pulmonary disease. 15 One of the important questions in the assessment of subjects with CIDP is the reliability of patient-reported subjective improvement.…”

Rate of continued conservative management versus progression to surgery at minimum 1‐year follow‐up in patients with pre‐arthritic hip pain

“…40 MCIDs for PROMIS measures in the hip population are less established, but likely only the PROMIS Pediatric Pain Interference and Mobility measures were meaningfully worse in the surgical cohort (before adjusting for other variables). [41][42][43] Regarding radiographic measurements, maximum α angle was only a predictor of progression to surgery for patients with severe radiographic cam FAI, possibly because patients' true FAI morphology is not completely captured on two-dimensional radiographs and/or because patients' activities, movement patterns, and other variables play a meaningful role in the responsiveness of structural FAI morphology to conservative management. 14,44,45 This modest association between α angle and clinical course is consistent with previous literature.…”

Determining Clinically Meaningful Outcomes after Isolated Acetabuloplasty in the Context of Age and Arthritic Severity: A Retrospective Review of Prospectively Collected Data

“…In the face of this expansion, it is important to keep in mind that defining clinically significant outcomes using CIOVs lends itself to variable interpretation depending on which values are used as well as which methodology was employed to arrive to the values (e.g., anchor-based vs. distribution-based calculation of MCID). For PROMIS-PF and PROMIS-PI, multiple MCID 32,33,44 and PASS 32,33 values have been reported. To ensure the most certain interpretation of our results based on the available literature, we ultimately decided to use the CIOV values of Kuhns et al because, to our knowledge, they were the highest threshold values reported in the hip arthroscopy literature for PROMIS-PF and PROMIS-PI.…”

“…32 Similarly, the postop PROMIS-PF and PROMIS-PI scores for each patient were characterized based on whether they surpassed PASS threshold values as described by Kuhns et al (51.8 for PROMIS-PF, 51.9 for PROMIS-PI). 32 Achieving any of these CIOV values was interpreted as a clinically favorable outcome. 32,33,43 Secondary outcomes included complications and revision surgeries, which were extracted from the EMR.…”

“…32 Achieving any of these CIOV values was interpreted as a clinically favorable outcome. 32,33,43 Secondary outcomes included complications and revision surgeries, which were extracted from the EMR.…”