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The Minimal Clinically Important Difference of the PROMIS and QuickDASH Instruments in a Nonshoulder Hand and Upper Extremity Patient Population

https://doi.org/10.1016/j.jhsa.2019.12.002Get rights and content

Purpose

The minimal clinically important difference (MCID) is used in research and clinical settings as a benchmark to gauge improvement following treatment. The purpose of this study was to provide anchor-based MCID estimates for Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy instruments in a nonshoulder hand and upper extremity population.

Methods

Adult patients (≥18 years) seeking care at a tertiary academic outpatient hand surgery clinic completed patient-reported outcome measures on tablet computers between January 2015 and August 2017. Data were collected at baseline and at 6 ± 2 weeks of follow-up. The PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) Computer Adaptive Test (CAT) instruments were administered, along with the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH). A mean change anchor-based method was used to estimate MCIDs by comparing scores between anchor groups reporting no change versus slightly improved in terms of function and pain.

Results

Scores for each instrument significantly improved over the study period. With significant differences in scores between groups reporting no change and slightly improved function, anchor-based MCID estimates were calculated as follows: 2.1 for the PROMIS UE CAT, 1.7 for the PROMIS PF CAT, and 6.8 for the QuickDASH. There was no significant difference in PROMIS PI CAT scores between anchor groups when queried for level of pain improvement, precluding estimation of an anchor-based MCID.

Conclusions

We have provided anchor-based MCID estimates for the PROMIS UE CAT, PROMIS PF CAT, and the QuickDASH for a general nonshoulder hand and upper extremity population. These values may be useful in future research for informing power calculations and when interpreting whether the magnitude of change on these instruments is clinically significant at a population level.

Clinical relevance

This study provides clinicians with a reference for values that may reflect clinically meaningful changes in scores for patient-reported outcome instruments commonly utilized in the current hand surgery literature.

Section snippets

Data collection

Institutional review board approval was obtained prior to the start of data collection. Patients seeking care at a university orthopedic clinic for nonshoulder hand and upper extremity conditions were prospectively asked to complete demographic and physical function questionnaires on hand-held tablet computers prior to seeing 1 of 4 fellowship-trained orthopedic hand surgeons. All patients were aged 18 years or older and sought care for their baseline visit between January 2015 and August 2017.

Results

A total of 847 patients were included in the study. Average age was 45.4 ± 18 years, and 420 (50%) were male and 427 (50%) were female. For patients who completed at least 1 of the 3 instruments assessing function (UE CAT, PF CAT, QuickDASH), comparisons in baseline patient characteristics between groups reporting no change and slightly improved are shown in Table 1. There were no significant differences in basic demographic factors between groups reporting no change and slightly improved on

Discussion

As patient-reported outcome measures are integrated into clinical care,18 the interpretability of scores becomes increasingly important. The use of PROMIS instruments can make important contributions to clinical practice,19 but it is important to understand how patients perceive changes in scores. The present study expands the evaluation of MCIDs for the PROMIS UE CAT and PROMIS PF CAT to a nonshoulder hand and upper extremity patient population.

Our MCID estimate for the PROMIS UE CAT was 2.1.

Acknowledgments

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002538.

References (33)

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