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Published in: Clinical Orthopaedics and Related Research® 4/2017

01-04-2017 | In Brief

Statistics In Brief: Minimum Clinically Important Difference—Availability of Reliable Estimates

Authors: Mitchell Maltenfort, PhD, Claudio Díaz-Ledezma, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2017

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Excerpt

To enter the era of value-based orthopaedics (“health outcomes per dollar spent”) [2, 19], clinical researchers will have to prove that each treatment produces a meaningful clinical improvement using outcomes that are relevant for patients. The American Association of Hip and Knee Surgeons has recommended the use of patient-reported outcome measures to evaluate the results of knee and hip arthroplasties [16]. Studies have focused on statistically detectable (sometimes called statistically significant) differences [35]; however, it can be possible to detect statistical differences between interventions that are so small as not to be discernible to patients. Such small differences may not justify the cost or risk of the intervention. It seems much more important that treatments should result in clinical improvements big enough for patients to consider clinically important. …
Literature
1.
go back to reference Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79:371–383.PubMed Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79:371–383.PubMed
3.
go back to reference Carragee EJ, Cheng I. Minimum acceptable outcomes after lumbar spinal fusion. Spine J. 2010;10:313–320.CrossRefPubMed Carragee EJ, Cheng I. Minimum acceptable outcomes after lumbar spinal fusion. Spine J. 2010;10:313–320.CrossRefPubMed
4.
go back to reference Clement ND, Duckworth AD, Jenkins PJ, McEachan JE. Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction. J Hand Sur Eur Vol. 2016;41:624–631.CrossRef Clement ND, Duckworth AD, Jenkins PJ, McEachan JE. Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction. J Hand Sur Eur Vol. 2016;41:624–631.CrossRef
5.
6.
go back to reference Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C. Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery. J Clin Epidemiol. 2014;67:697–705.CrossRefPubMed Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C. Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery. J Clin Epidemiol. 2014;67:697–705.CrossRefPubMed
7.
go back to reference Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Carr A. Comparative responsiveness and minimal change for the Oxford Elbow Score following surgery. Qual Life Res. 2008;17:1257–1267.CrossRefPubMed Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Carr A. Comparative responsiveness and minimal change for the Oxford Elbow Score following surgery. Qual Life Res. 2008;17:1257–1267.CrossRefPubMed
8.
go back to reference Dawson J, Doll H, Coffey J, Jenkinson C; Oxford and Birmingham Foot and Ankle Clinical Research Group. Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage. 2007;15:918–931.CrossRefPubMed Dawson J, Doll H, Coffey J, Jenkinson C; Oxford and Birmingham Foot and Ankle Clinical Research Group. Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage. 2007;15:918–931.CrossRefPubMed
9.
go back to reference Ebert JR, Smith A, Wood DJ, Ackland TR. A comparison of the responsiveness of 4 commonly used patient-reported outcome instruments at 5 years after matrix-induced autologous chondrocyte implantation. Am J Sports Med. 2013;41:2791–2799.CrossRefPubMed Ebert JR, Smith A, Wood DJ, Ackland TR. A comparison of the responsiveness of 4 commonly used patient-reported outcome instruments at 5 years after matrix-induced autologous chondrocyte implantation. Am J Sports Med. 2013;41:2791–2799.CrossRefPubMed
10.
go back to reference Impellizzeri FM, Mannion AF, Naal FD, Hersche O, Leunig M. The early outcome of surgical treatment for femoroacetabular impingement: success depends on how you measure it. Osteoarthritis Cartilage. 2012;20:638–645.CrossRefPubMed Impellizzeri FM, Mannion AF, Naal FD, Hersche O, Leunig M. The early outcome of surgical treatment for femoroacetabular impingement: success depends on how you measure it. Osteoarthritis Cartilage. 2012;20:638–645.CrossRefPubMed
11.
go back to reference Katz NP, Paillard FC, Ekman E. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res. 2015;10:24.CrossRefPubMedPubMedCentral Katz NP, Paillard FC, Ekman E. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res. 2015;10:24.CrossRefPubMedPubMedCentral
12.
go back to reference Keurentjes JC, Van Tol FR, Fiocco M, Schoones JW, Nelissen RG. Minimal clinically important differences in health-related quality of life after total hip or knee replacement: a systematic review. Bone Joint Res. 2012;1:71–77.CrossRefPubMedPubMedCentral Keurentjes JC, Van Tol FR, Fiocco M, Schoones JW, Nelissen RG. Minimal clinically important differences in health-related quality of life after total hip or knee replacement: a systematic review. Bone Joint Res. 2012;1:71–77.CrossRefPubMedPubMedCentral
13.
go back to reference Kim JK, Jeon SH. Minimal clinically important differences in the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Eur Vol. 2013;38:75–79.CrossRef Kim JK, Jeon SH. Minimal clinically important differences in the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Eur Vol. 2013;38:75–79.CrossRef
14.
go back to reference Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res. 2013;471:1406–1411.CrossRefPubMedPubMedCentral Kim JK, Park ES. Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome. Clin Orthop Relat Res. 2013;471:1406–1411.CrossRefPubMedPubMedCentral
15.
go back to reference Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis. 2007;66(suppl 3):iii40–iii41. Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis. 2007;66(suppl 3):iii40–iii41.
16.
go back to reference Lieberman JR. American Association of Hip and Knee Surgeons and outcome measures after total joint arthroplasty. J Arthroplasty. 2016;31:1137–1138.CrossRefPubMed Lieberman JR. American Association of Hip and Knee Surgeons and outcome measures after total joint arthroplasty. J Arthroplasty. 2016;31:1137–1138.CrossRefPubMed
17.
go back to reference Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11:587–594.CrossRefPubMed Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11:587–594.CrossRefPubMed
18.
go back to reference Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–592.PubMed Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–592.PubMed
20.
go back to reference Ozer K, Malay S, Toker S, Chung KC. Minimal clinically important difference of carpal tunnel release in diabetic and nondiabetic patients. Plast Reconstr Surg. 2013;131:1279–1285.CrossRefPubMedPubMedCentral Ozer K, Malay S, Toker S, Chung KC. Minimal clinically important difference of carpal tunnel release in diabetic and nondiabetic patients. Plast Reconstr Surg. 2013;131:1279–1285.CrossRefPubMedPubMedCentral
21.
go back to reference Parker SL, Mendenhall SK, Shau DN, Adogwa O, Anderson WN, Devin CJ, McGirt MJ. Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine. 2012;16:471–478.CrossRefPubMed Parker SL, Mendenhall SK, Shau DN, Adogwa O, Anderson WN, Devin CJ, McGirt MJ. Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same-level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine. 2012;16:471–478.CrossRefPubMed
22.
go back to reference Paulsen A, Roos EM, Pedersen AB, Overgaard S. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthop. 2014;85:39–48.CrossRefPubMedPubMedCentral Paulsen A, Roos EM, Pedersen AB, Overgaard S. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively. Acta Orthop. 2014;85:39–48.CrossRefPubMedPubMedCentral
23.
go back to reference Singh JA, Luo R, Landon GC, Suarez-Almazor M. Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: a multicenter study. J Rheumatol. 2014;41:509–515.CrossRefPubMedPubMedCentral Singh JA, Luo R, Landon GC, Suarez-Almazor M. Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: a multicenter study. J Rheumatol. 2014;41:509–515.CrossRefPubMedPubMedCentral
24.
go back to reference Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord. 2016;17:256.CrossRefPubMedPubMedCentral Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord. 2016;17:256.CrossRefPubMedPubMedCentral
25.
go back to reference Singh JA, Schleck C, Harmsen WS, Lewallen DG. Validation of the Mayo Hip Score: construct validity, reliability and responsiveness to change. BMC Musculoskelet Disord. 2016;17:39.CrossRefPubMedPubMedCentral Singh JA, Schleck C, Harmsen WS, Lewallen DG. Validation of the Mayo Hip Score: construct validity, reliability and responsiveness to change. BMC Musculoskelet Disord. 2016;17:39.CrossRefPubMedPubMedCentral
26.
go back to reference Skolasky RL, Albert TJ, Maggard AM, Riley LH 3rd. Minimum clinically important differences in the Cervical Spine Outcomes Questionnaire: results from a national multicenter study of patients treated with anterior cervical decompression and arthrodesis. J Bone Joint Surg. Am. 2011;93:1294–1300.CrossRefPubMed Skolasky RL, Albert TJ, Maggard AM, Riley LH 3rd. Minimum clinically important differences in the Cervical Spine Outcomes Questionnaire: results from a national multicenter study of patients treated with anterior cervical decompression and arthrodesis. J Bone Joint Surg. Am. 2011;93:1294–1300.CrossRefPubMed
27.
go back to reference Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013;38:641–649.CrossRefPubMedPubMedCentral Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013;38:641–649.CrossRefPubMedPubMedCentral
28.
go back to reference Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP. Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am. 2010;92:296–303.CrossRefPubMed Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP. Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am. 2010;92:296–303.CrossRefPubMed
29.
go back to reference Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings MG. The minimum clinically important difference of the Modified Japanese Orthopaedic Association Scale in patients with degenerative cervical myelopathy. Spine (Phila Pa 1976). 2015;40:1653–1659. Tetreault L, Nouri A, Kopjar B, Côté P, Fehlings MG. The minimum clinically important difference of the Modified Japanese Orthopaedic Association Scale in patients with degenerative cervical myelopathy. Spine (Phila Pa 1976). 2015;40:1653–1659.
30.
go back to reference Tonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K, Chikuda H. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J. 2012;21:1596–1602.CrossRefPubMedPubMedCentral Tonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K, Chikuda H. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J. 2012;21:1596–1602.CrossRefPubMedPubMedCentral
31.
go back to reference Tubach F, Ravaud P, Beaton D, Boers M, Bombardier C, Felson DT, van der Heijde D, Wells G, Dougados M. Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol. 2007;34:1188–1193.PubMedPubMedCentral Tubach F, Ravaud P, Beaton D, Boers M, Bombardier C, Felson DT, van der Heijde D, Wells G, Dougados M. Minimal clinically important improvement and patient acceptable symptom state for subjective outcome measures in rheumatic disorders. J Rheumatol. 2007;34:1188–1193.PubMedPubMedCentral
33.
go back to reference Wang YC, Hart DL, Stratford PW, Mioduski JE. Baseline dependency of minimal clinically important improvement. Phys Ther. 2011;91:675–688.CrossRefPubMed Wang YC, Hart DL, Stratford PW, Mioduski JE. Baseline dependency of minimal clinically important improvement. Phys Ther. 2011;91:675–688.CrossRefPubMed
34.
go back to reference Werner BC, Chang B, Nguyen JT, Dines DM, Gulotta LV. What change in American Shoulder and Elbow Surgeons Score represents a clinically important change after shoulder arthroplasty? Clin Orthop Relat Res. 2016;474:2672–2681.CrossRefPubMed Werner BC, Chang B, Nguyen JT, Dines DM, Gulotta LV. What change in American Shoulder and Elbow Surgeons Score represents a clinically important change after shoulder arthroplasty? Clin Orthop Relat Res. 2016;474:2672–2681.CrossRefPubMed
35.
go back to reference Wright A, Hannon J, Hegedus EJ, Kavchak AE. Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther. 2012;20:160–166.CrossRefPubMedPubMedCentral Wright A, Hannon J, Hegedus EJ, Kavchak AE. Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther. 2012;20:160–166.CrossRefPubMedPubMedCentral
36.
go back to reference Zhou F, Zhang Y, Sun Y, Zhang F, Pan S, Liu Z. Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J. 2015;24:2918–2923.CrossRefPubMed Zhou F, Zhang Y, Sun Y, Zhang F, Pan S, Liu Z. Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J. 2015;24:2918–2923.CrossRefPubMed
37.
go back to reference Zuckerman SL, Chotai S, Devin CJ, Parker SL, Stonko DP, Wick JB, Hale AT, McGirt MJ, Cheng JS. Surgical resection of intradural extramedullary spinal tumors: patient reported outcomes and minimum clinically important difference. Spine (Phila Pa 1976). 2016 Apr 20. [Epub ahead of print] Zuckerman SL, Chotai S, Devin CJ, Parker SL, Stonko DP, Wick JB, Hale AT, McGirt MJ, Cheng JS. Surgical resection of intradural extramedullary spinal tumors: patient reported outcomes and minimum clinically important difference. Spine (Phila Pa 1976). 2016 Apr 20. [Epub ahead of print]
Metadata
Title
Statistics In Brief: Minimum Clinically Important Difference—Availability of Reliable Estimates
Authors
Mitchell Maltenfort, PhD
Claudio Díaz-Ledezma, MD
Publication date
01-04-2017
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 4/2017
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-016-5204-6

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