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A Novel Methodology for Establishing Best Values for MCID, SCB, and PASS Thresholds for Rotator Cuff Repair
Alexander C Lee1, Joshua Chiang2, Xinning Li3
1Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
This systematic review establishes standardized threshold values for minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) in rotator cuff repair. These recommendations aim to improve the utility of these outcome measures in clinical practice and research.
Area of Science:
- Orthopedics
- Clinical Outcomes Research
- Health Services Research
Background:
- Heterogeneity in threshold values for MCID, SCB, and PASS in rotator cuff repair literature limits their clinical utility.
- A systematic review was conducted to address this heterogeneity and establish reliable values.
- The study focuses on patient-reported outcome measures (PROMs) crucial for assessing rotator cuff repair outcomes.
Purpose of the Study:
- To recommend standardized threshold values for MCID, SCB, and PASS for commonly used PROMs in rotator cuff repair.
- To propose a methodologic framework for calculating these thresholds in future research.
- To enhance the consistency and comparability of study results in rotator cuff repair.
Main Methods:
- Systematic review of studies published between January 1, 2000, and May 31, 2022, reporting MCID, SCB, and PASS thresholds for rotator cuff repair.
- Data extraction included follow-up duration, patient attrition, threshold values, and calculation methods (anchor-based vs. distribution-based).
- Prioritization of values derived from anchor-based methods, receiver operator characteristic analysis, and multi-option anchor questions.
Main Results:
- 41 studies were reviewed, reporting on MCID (90%), SCB (27%), and PASS (39%) thresholds.
- Recommended threshold values were established for MCID, SCB, and PASS across several PROMs, including ASES, VAS for pain, SANE, UCLA, and Constant-Murley scores.
- Anchor-based methods were more frequently used (12 studies) compared to distribution-based methods (6 studies).
Conclusions:
- Standardized MCID, SCB, and PASS thresholds can significantly enhance comparative studies, inform reimbursement policies, and aid patient decision-making in rotator cuff repair.
- Future research should collect preoperative and 12-month postoperative PROM data using anchor questions focused on overall satisfaction with multiple response options.
- Recommended calculation methods involve correlating data via receiver operator characteristic analysis and comparing values with standard error of the mean or minimal detectable change.
