Clinical Practice Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2018; 9(3): 41-49
Published online Mar 18, 2018. doi: 10.5312/wjo.v9.i3.41
Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics
Man Hung, Jerry Bounsanga, Maren W Voss, Charles L Saltzman
Man Hung, Jerry Bounsanga, Maren W Voss, Charles L Saltzman, Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT 84108, United States
Man Hung, Division of Public Health, University of Utah, Salt Lake City, UT 84108, United States
Man Hung, Population Health Research Foundation, University of Utah, Salt Lake City, UT 84112, United States
Author contributions: Hung M was instrumental in study design, data collection, data processing, data analysis, interpretation, study oversight, literature review, manuscript writing and editing; Bounsanga J was instrumental in data processing, data analysis, manuscript writing and editing; Voss MW was instrumental in literature review, data analysis, manuscript writing and editing; Saltzman CL was instrumental in study design, data collection, interpretation and manuscript editing.
Supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health, No. U01AR067138. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Institutional review board statement: Institutional review board approval/waiver was obtained through the University of Utah, IRB #00053404.
Informed consent statement: Study participants completed PRO measures as part of the standard of care in treatment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: The dataset analyzed during the current study is not publicly available due to HIPAA regulations but may be available from the University of Utah if the requestor has obtained proper IRB approval from the University of Utah and its Enterprise Data Warehouse.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Man Hung, PhD, Associate Professor, Department of Orthopaedic Surgery Operations, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States. man.hung@hsc.utah.edu
Telephone: +1-801-5875372 Fax: +1-801-5875411
Received: January 4, 2018
Peer-review started: January 4, 2018
First decision: January 23, 2018
Revised: January 30, 2018
Accepted: February 6, 2018
Article in press: February 6, 2018
Published online: March 18, 2018
Processing time: 70 Days and 15.4 Hours
Abstract
AIM

To establish minimum clinically important difference (MCID) for measurements in an orthopaedic patient population with joint disorders.

METHODS

Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS® PF) computerized adaptive test (CAT), hip disability and osteoarthritis outcome score for joint reconstruction (HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction (KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchor-based and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.

RESULTS

There were 2226 patients who participated with a mean age of 61.16 (SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS® PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS® PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.

CONCLUSION

This is the first comprehensive study providing a wide range of MCIDs for the PROMIS® PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Keywords: Hhip disability and osteoarthritis outcome score for joint reconstruction; Patient-Reported Outcomes Measurement Information System Physical Function; Knee injury and osteoarthritis outcome score for joint reconstruction; Minimum clinically important difference; Joint; Physical function; Minimum detectable change; Arthroplasty; Orthopaedics; Clinical outcomes

Core tip: Personal value judgments should be used to apply these minimum clinically important difference (MCID) values to treatment planning and in guiding patient expectations of change. We recommend applying low values of MCIDs for screening purposes and median values as a more conservative cut-off for evaluating longitudinal change.