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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2013

Open Access 01-12-2013 | Research article

Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs)

Authors: Derk A van Kampen, W Jaap Willems, Loes W A H van Beers, Rene M Castelein, Vanessa A B Scholtes, Caroline B Terwee

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2013

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Abstract

Background

There is a need for better interpretation of orthopedic treatment effects. Patient-reported outcome measures (PROMs) are already commonly used for patient evaluation. PROMs can be used to determine treatment effects in research as well as in clinical settings by calculating change scores, with pre- and post-treatment evaluation. The smallest detectable change (SDC) and minimal important change (MIC) are two important benchmarks for interpreting these change scores. The purpose was to determine the SDC and the MIC for four commonly used shoulder-related PROMs: Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder and Hand (DASH and Quick DASH), and the Oxford Shoulder Score (OSS).

Methods

A cohort of 164 consecutive patients with shoulder problems visiting an orthopedic outpatient clinic completed the SST, DASH, and the OSS at their first visit and 6 months after operative or non-operative treatment. The SDC was calculated with a test re-test protocol (0–2 weeks). For the MIC, change scores (0–6 months of evaluation) were calculated in seven subgroups of patients, according to an additional self-administered ranking of change over time (anchor-based mean change technique). The MIC is defined as the average score of the ‘slightly improved’ group according to the anchor. The Quick DASH was computed from the DASH.

Results

The SDC of the SST was 2.8, DASH 16.3, Quick DASH 17.1, and OSS 6.0. The MIC change score for the SST was 2.2, DASH 12.4, Quick DASH 13.4, and OSS 6.0.

Conclusion

This study shows that on an individual patient-based level, when taking into account SDC and MIC, the change score should exceed 2.8 points for the SST, 16.3 points for the DASH, 17.1 points for the Quick DASH, and 6.0 points for the OSS to have a clinically relevant change on a PROM, which is not due to measurement error.
Appendix
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Literature
1.
Turkelson CM, Zhao G: Musculoskeletal Conditions and Disorders: Occurrence and Healthcare Use in the United States. Rosemont: Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons,http://​www.​aaos.​org/​,
2.
Patrick DL, Burke LB, Powers JH, Scott JA, Rock EP, Dawisha S, O'Neill R, Kennedy DL: Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Health. 2007, 10 (Suppl 2): S125-S137.CrossRefPubMed
3.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW: The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010, 19: 539-549. 10.1007/s11136-010-9606-8.PubMedCentralCrossRefPubMed
4.
Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HCW: Protocol of the COSMIN study: COnsensus-based standards for the selection of health measurement instruments. BMC Med Res Methodol. 2006, 6: 2-10.1186/1471-2288-6-2.PubMedCentralCrossRefPubMed
5.
de Vet HCW, Terwee CB, Mokkink LB, Knol DL: Measurement in Medicine. 2011, New York: Cambridge University PressCrossRef
6.
Jaeschke R, Singer J, Guyatt GH: Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989, 10: 407-415. 10.1016/0197-2456(89)90005-6.CrossRefPubMed
7.
Redelmeier DA, Lorig K: Assessing the clinical importance of symptomatic improvements. An illustration in rheumatology. Arch Intern Med. 1993, 153: 1337-1342. 10.1001/archinte.1993.00410110045008.CrossRefPubMed
8.
Terwee CB, Roorda LD, Knol DL, De Boer MR, de Vet HCW: Linking measurement error to minimal important change of patient-reported outcomes. J Clin Epidemiol. 2009, 62: 1062-1067. 10.1016/j.jclinepi.2008.10.011.CrossRefPubMed
9.
Schünemann HJ, Akl EA, Guyatt GH: Interpreting the results of patient reported outcome measures in clinical trials: the clinician's perspective. Health Qual Life Outcomes. 2006, 4: 62-10.1186/1477-7525-4-62.PubMedCentralCrossRefPubMed
10.
Beaton DE, van Eerd D, Smith P, van der Velde G, Cullen K, Kennedy CA, Hogg-Johnson S: Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability. J Clin Epidemiol. 2011, 64: 487-496. 10.1016/j.jclinepi.2010.07.012.CrossRefPubMed
11.
Gummesson C, Atroshi I, Ekdahl C: The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003, 4: 11-10.1186/1471-2474-4-11.PubMedCentralCrossRefPubMed
12.
Mintken PE, Glynn P, Cleland JA: Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and numeric pain rating scale in patients with shoulder pain. J Shoulder Elbow Surg. 2009, 18: 920-926. 10.1016/j.jse.2008.12.015.CrossRefPubMed
13.
Polson K, Reid D, McNair PJ, Larmer P: Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther. 2010, 15: 404-407. 10.1016/j.math.2010.03.008.CrossRefPubMed
14.
Schmitt JS, Di Fabio RP: Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004, 57: 1008-1018. 10.1016/j.jclinepi.2004.02.007.CrossRefPubMed
15.
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. 2010, 92: 296-303. 10.2106/JBJS.H.01296.CrossRefPubMed
16.
Gabel CP, Michener LA, Burkett B, Neller A: The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness. J Hand Ther. 2006, 19: 328-348. 10.1197/j.jht.2006.04.001. quiz 349CrossRefPubMed
17.
Gabel CP, Michener LA, Melloh M, Burkett B: Modification of the upper limb functional index to a three-point response improves clinimetric properties. J Hand Ther. 2010, 23: 41-51. 10.1016/j.jht.2009.09.007. quiz 52CrossRefPubMed
18.
Roy J-S, MacDermid JC, Faber KJ, Drosdowech DS, Athwal GS: The simple shoulder test is responsive in assessing change following shoulder arthroplasty. J Orthop Sports Phys Ther. 2010, 40: 413-421. 10.2519/jospt.2010.3209.CrossRefPubMed
19.
Terwee CB, Mokkink LB, Knol DL, Ostelo RWJG, Bouter LM, de Vet HCW: Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012, 21: 651-657. 10.1007/s11136-011-9960-1.PubMedCentralCrossRefPubMed
20.
Lippitt SB, Matsen FA: A practical tool for evaluating function: the simple shoulder test. The Shoulder: A Balance of Mobility and Stability. 1993, Rosemont: American Academy of Orthopaedic Surgeons, 545-559.
21.
Lippitt SB, Harryman DT, Matsen FA: The Shoulder: A Balance of Mobility and Stability. 1993, Rosemont: American Academy of Orthopedic Surgeons, 501-518.
22.
Beaton D, Richards RR: Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg. 1998, 7: 565-572. 10.1016/S1058-2746(98)90002-7.CrossRefPubMed
23.
Lippitt SB, Matsen FA: A practical tool for evaluating function: the simple shoulder test. The Shoulder: A Balance of Mobility and Stability. 1993, Rosemont: American Academy of Orthopaedic Surgeons
24.
van Kampen DA, van Beers LWAH, Scholtes VAB, Terwee CB, Willems WJ: Validation of the Dutch version of the simple shoulder test. J Shoulder Elbow Surg. 2011, 21 (6): 808-814.CrossRefPubMed
25.
Hudak PL, Amadio PC, Bombardier C: The upper extremity collaborative Group (UECG): development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med. 1996, 29: 602-608. 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.CrossRefPubMed
26.
Kennedy CA, Beaton DE, Solway S, McConeell S, Bombardier C: The DASH and QuickDASH Outcome Measure User’s Manual. 2011, Toronto: Institute of Work & Health, 3
27.
Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C: Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001, 14: 128-146. 10.1016/S0894-1130(01)80043-0.CrossRefPubMed
28.
Desai AS, Dramis A, Hearnden AJ: Critical appraisal of subjective outcome measures used in the assessment of shoulder disability. Ann R Coll Surg Engl. 2010, 92: 9-13.PubMedCentralCrossRefPubMed
29.
Veehof MM, Sleegers EJA, van Veldhoven NHMJ, Schuurman AH, van Meeteren NLU: Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV). J Hand Ther. 2002, 15: 347-354. 10.1016/S0894-1130(02)80006-0.CrossRefPubMed
30.
Beaton DE, Wright JG, Katz JN: Upper extremity collaborative group: development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005, 87: 1038-1046. 10.2106/JBJS.D.02060.CrossRefPubMed
31.
Dawson J, Fitzpatrick R, Carr A: Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996, 78: 593-600.PubMed
32.
Cloke DJ, Lynn SE, Watson H, Steen IN, Purdy S, Williams JR: A comparison of functional, patient-based scores in subacromial impingement. J Shoulder Elbow Surg. 2005, 14: 380-384. 10.1016/j.jse.2004.08.008.CrossRefPubMed
33.
Berendes T, Pilot P, Willems WJ, Verburg H, Slaa te R: Validation of the Dutch version of the Oxford Shoulder Score. J Shoulder Elbow Surg. 2010, 19: 829-836. 10.1016/j.jse.2010.01.017.CrossRefPubMed
34.
de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM: Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes. 2006, 4: 54-10.1186/1477-7525-4-54.PubMedCentralCrossRefPubMed
35.
Revicki D, Hays RD, Cella D, Sloan J: Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008, 61: 102-109. 10.1016/j.jclinepi.2007.03.012.CrossRefPubMed
36.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW: The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010, 63: 737-745. 10.1016/j.jclinepi.2010.02.006.CrossRefPubMed
37.
de Vet HCW, Terwee CB, Knol DL, Bouter LM: When to use agreement versus reliability measures. J Clin Epidemiol. 2006, 59: 1033-1039. 10.1016/j.jclinepi.2005.10.015.CrossRefPubMed
38.
Stratford PW, Riddle DL: When minimal detectable change exceeds a diagnostic test-based threshold change value for an outcome measure: resolving the conflict. Phys Ther. 2012, 92: 1338-1347. 10.2522/ptj.20120002.CrossRefPubMed
39.
Lu WS, Wang CH, Lin JH, Sheu CF, Hsieh CL: The minimal detectable change of the simplified stroke rehabilitation assessment of movement measure. J Rehabil Med. 2008, 40: 615-619. 10.2340/16501977-0230.CrossRefPubMed
40.
Martin Bland J, Altman D: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986, 327: 307-310. 10.1016/S0140-6736(86)90837-8.CrossRef
41.
Crosby RD, Kolotkin RL, Williams GR: Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003, 56: 395-407. 10.1016/S0895-4356(03)00044-1.CrossRefPubMed
42.
Hays RD, Farivar SS, Liu H: Approaches and recommendations for estimating minimally important differences for health-related quality of life measures. COPD. 2005, 2: 63-67. 10.1081/COPD-200050663.CrossRefPubMed
43.
Norman GR, Stratford P, Regehr G: Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach. J Clin Epidemiol. 1997, 50: 869-879. 10.1016/S0895-4356(97)00097-8.CrossRefPubMed
44.
Angst F, Schwyzer H-K, Aeschlimann A, Simmen BR, Goldhahn J: Measures of adult shoulder function: disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res. 2011, 63: S174-S188. 10.1002/acr.20630.CrossRef
45.
King M: A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011, 11: 171-184. 10.1586/erp.11.9.CrossRefPubMed
46.
Terwee CB, Roorda LD, Dekker J, Bierma-Zeinstra SM, Peat G, Jordan KP, Croft P, de Vet HCW: Mind the MIC: large variation among populations and methods. J Clin Epidemiol. 2010, 63: 524-534. 10.1016/j.jclinepi.2009.08.010.CrossRefPubMed
47.
Yost KJ, Eton DT, Garcia SF, Cella D: Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. J Clin Epidemiol. 2011, 64: 507-516. 10.1016/j.jclinepi.2010.11.018.PubMedCentralCrossRefPubMed
Metadata
Title
Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs)
Authors
Derk A van Kampen
W Jaap Willems
Loes W A H van Beers
Rene M Castelein
Vanessa A B Scholtes
Caroline B Terwee
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2013
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-8-40

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