PROMIS Minimal Clinically Important Differences Across Foot and Ankle Surgeries

Area of Science:

• Orthopedic Surgery
• Patient-Reported Outcomes
• Clinical Significance

Background:

• Minimal clinically important differences (MCIDs) are crucial for interpreting patient-reported outcome measures (PROMs).
• The threshold for meaningful improvement may differ based on individual patient characteristics.
• This study examines how surgery type and demographics influence MCID in foot and ankle patients.

Purpose of the Study:

• To investigate the impact of surgical procedure and patient demographics on MCID.
• To establish benchmarks for meaningful improvement in foot and ankle surgery outcomes.
• To enhance the utility of PROMs in clinical practice.

Main Methods:

• Retrospective analysis of foot and ankle patients from a single institution's PRO registry.
• Inclusion criteria: preoperative and ≥180-day follow-up for PROMIS Physical Function (PF) and Pain Interference (PI) CAT.
• Foot and Ankle Single Assessment Numeric Evaluation (FA SANE) used as an anchor for MCID calculations across 11 surgical categories, sex, BMI, and SDI.

Main Results:

• 1243 patients with an average follow-up of 456 days showed significant improvements in PF (8.2) and PI (-8.1).
• Global MCID estimates were 5.5 for PF and -5.8 for PI, anchored to FA SANE.
• Surgery type significantly impacted MCID (e.g., 2.3/-3.8 for hardware removal to 15.7/-9.8 for soft tissue surgery); demographic variations were minimal (<1.9 points).

Conclusions:

• Postoperative improvements of ≥5.5 in PF and ≤-4.8 in PI suggest meaningful change.
• MCID values vary significantly across foot and ankle surgical procedures.
• Patient-specific MCIDs, rather than a global estimate, better reflect true meaningful change, supported by FA SANE anchoring.