Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome

Area of Science:

• Orthopedics
• Musculoskeletal Diseases
• Surgical Outcomes

Background:

• Patient-reported outcomes (PROs) are crucial for assessing musculoskeletal disease severity and function.
• Questionnaires can detect clinical changes, but their responsiveness in ulnar impaction syndrome (UIS) is not well-established.

Purpose of the Study:

• To compare the responsiveness of the Patient-Rated Wrist Evaluation (PRWE) and DASH questionnaires against physical measures in detecting clinical improvements in UIS.
• To determine the minimal clinically important difference (MCID) for the PRWE and DASH following ulnar shortening osteotomy (USO) for idiopathic UIS.

Main Methods:

• Prospective study of patients undergoing USO for idiopathic UIS.
• Patients completed PRWE and DASH questionnaires, and underwent grip strength and wrist range of motion (ROM) assessments preoperatively and 12 months postoperatively.
• Effect sizes were calculated to compare instrument responsiveness; patient-perceived improvement served as an anchor for MCID determination.

Main Results:

• Most patient-reported scores improved post-surgery, with the PRWE demonstrating higher sensitivity than the DASH and physical measures.
• Effect sizes: PRWE (1.51), DASH (1.12), grip strength (0.59), wrist pronation (0.33), wrist extension (0.28).
• MCID was 17 points for PRWE and 13.5 points for DASH; minimal detectable changes were 7.7 (PRWE) and 9.3 (DASH).

Conclusions:

• The PRWE is more sensitive than the DASH and physical measures in detecting clinical changes after USO for idiopathic UIS.
• A 17-point improvement on the PRWE or 13.5 points on the DASH is considered clinically important by patients.
• The MCID values exceed measurement errors, indicating reliable detection of meaningful patient improvement.