Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty
Aksel Paulsen1, Ewa M Roos, Alma B Pedersen
1Department of Orthopaedic Surgery and Traumatology , Odense University Hospital, Institute of Clinical Research , University of Southern Denmark.
Background And Purpose:
The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D.
Patients And Methods:
THA patients from 16 different departments received 2 PROs and additional questions preoperatively and 1 year postoperatively. The PROs included were the HOOS subscales pain (HOOS Pain), physical function short form (HOOS-PS), and hip-related quality of life (HOOS QoL), and the EQ-5D. MCII and PASS were estimated using multiple anchor-based approaches.
Results:
Of 1,837 patients available, 1,335 answered the preoperative PROs, and 1,288 of them answered the 1-year follow-up. The MCIIs and PASSs were estimated to be: 24 and 91 (HOOS Pain), 23 and 88 (HOOS-PS), 17 and 83 (HOOS QoL), 0.31 and 0.92 (EQ-5D Index), and 23 and 85 (EQ-VAS), respectively. MCIIs corresponded to a 38-55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57-91% of the maximum score in THA patients 1 year after surgery.
Interpretation:
This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide for future MCII and PASS estimations in other contexts. The cutoff points may serve as reference values in registry settings.
Insights
This study establishes reference values for minimal clinically important improvements and patient-acceptable symptom states for total hip arthroplasty patients using the HOOS and EQ-5D outcome scores. These findings enhance the interpretation of patient-reported outcomes in orthopedic research.
Area of Science:
- Orthopedics
- Health Outcomes Research
- Biostatistics
Background:
- Patient-reported outcomes (PROs) are increasingly vital in orthopedic surgery.
- Establishing clear benchmarks for minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) is crucial for interpreting PRO data after total hip arthroplasty (THA).
Purpose of the Study:
- To estimate MCII and PASS values one year post-THA for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D.
- To determine cut-points for clinically meaningful PRO changes and acceptable postoperative scores.
Main Methods:
- A cohort of 1,837 THA patients completed HOOS and EQ-5D questionnaires preoperatively and at 1-year follow-up.
- Multiple anchor-based approaches were utilized to estimate MCII and PASS values.
- Data from 1,288 patients who completed both assessments were analyzed.
Main Results:
- Estimated MCIIs ranged from 17 (HOOS QoL) to 24 (HOOS Pain), and PASSs ranged from 83 (HOOS QoL) to 91 (HOOS Pain).
- EQ-5D Index MCII was 0.31 and PASS was 0.92; EQ-VAS MCII was 23 and PASS was 85.
- MCIIs represented 38-55% improvement from baseline, while PASSs indicated 57-91% of maximum scores.
Conclusions:
- The study provides valuable reference values for MCII and PASS in THA patients, improving PRO score interpretability.
- The methodologies employed can guide future MCII and PASS estimations in diverse clinical contexts.
- These cut-off points can serve as benchmarks in orthopedic registries and clinical practice.
More Related Videos
08:40Author Spotlight: A Novel 3D-Printed Titanium Implant for Minimally Invasive Treatment of Hip Dysplasia in Young Dogs
Published on: April 19, 2024
06:28Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
Published on: December 13, 2024