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Minimal clinically important differences of 3 patient-rated outcomes instruments
Amelia A Sorensen1, Daniel Howard, Wen Hui Tan
1Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA.
The Journal of Hand Surgery
|March 14, 2013
Summary
Minimal clinically important differences (MCIDs) were defined for orthopedic outcome measures. A 10-point change on the Disabilities of the Arm, Shoulder, and Hand (DASH) and 14 points on the QuickDASH and Patient-Rated Wrist Evaluation (PRWE) signify important improvements.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Health Outcomes Research
Background:
- Patient-rated instruments are crucial for measuring orthopedic outcomes.
- Understanding the clinical relevance of score changes is essential for interpreting results.
Purpose of the Study:
- To define the minimal clinically important differences (MCIDs) for the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, and Patient-Rated Wrist Evaluation (PRWE) questionnaires.
- To establish benchmarks for meaningful change in hand, wrist, and forearm conditions.
Main Methods:
- Prospective analysis of 102 patients with atraumatic hand, wrist, and forearm conditions.
- Utilized an anchor-based approach to categorize patient-reported improvement (no change, minimal, marked).
- Calculated MCIDs as the mean change score in the minimal improvement group for DASH, QuickDASH, and PRWE.
Main Results:
- The MCID for DASH was 10 points (95% CI: 5-15).
- The MCID for QuickDASH was 14 points (95% CI: 9-20).
- The MCID for PRWE was 14 points (95% CI: 8-20).
- MCID values were significantly different from other change categories and correlated with baseline scores.
Conclusions:
- Longitudinal changes of 10 points (DASH) and 14 points (QuickDASH, PRWE) represent minimal clinically important improvements.
- Recommended for group-level analysis in research and sample size calculations.
- Provides a basis for interpreting the clinical significance of score changes in common patient-rated outcome measures.
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