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Clinically Relevant Thresholds in Patient-Reported Outcomes: Do Patients' Expectations Evolve Over Long-term

Elizabeth G Walsh^1,2, Tyler R McCarroll^1,2, Benjamin D Kuhns^1,2

¹American Hip Institute Research Foundation, Chicago, Illinois, USA.

The American Journal of Sports Medicine

|June 14, 2025

Summary

This summary is machine-generated.

This study defined clinically important thresholds for hip arthroscopy outcomes. Patients achieved high rates of minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) over 10 years, indicating evolving patient expectations.

Keywords:

Patient Acceptable Symptom State femoroacetabular impingement syndrome hip arthroscopy minimal clinically important difference patient expectations substantial clinical benefit

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Area of Science:

Orthopedic Surgery
Sports Medicine
Patient-Reported Outcomes

Background:

Clinically relevant thresholds are crucial for assessing postoperative functional status and patient satisfaction after hip arthroscopy.
Understanding these thresholds provides valuable insight into the effectiveness of surgical interventions and patient-reported outcomes.

Purpose of the Study:

To define and evaluate the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds.
These thresholds were assessed at 2-, 5-, and 10-year follow-up points using the modified Harris Hip Score (mHHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT12).

Main Methods:

Retrospective review of patients undergoing primary hip arthroscopy from 2008 to 2021.
Inclusion criteria required complete patient-reported outcome scores with anchor questions at 2, 5, or 10 years.
Propensity score matching was used to create comparable groups at each time point; thresholds were determined using an anchor-based method.

Main Results:

A total of 414 hips were analyzed, with thresholds demonstrating acceptable to excellent discrimination.
The percentage of patients achieving PASS and SCB increased from 2 to 10 years, suggesting evolving patient expectations.
MCID and the percentage of patients achieving it remained relatively constant over the follow-up periods.

Conclusions:

Patients demonstrated high rates of achieving MCID, PASS, and SCB thresholds over a 10-year period.
Patient expectations for functional outcomes appear to evolve over time, influencing the achievement of PASS and SCB.
Understanding the dynamic nature of patient expectations is vital for interpreting clinically relevant outcome thresholds in long-term studies.