Using the Quality Outcomes Database to Identify Minimum Clinically Important Differences for Patients With Cervical...

Area of Science:

• Orthopedics
• Neurosurgery
• Health Outcomes Research

Background:

• Cervical spondylotic myelopathy (CSM) treatment outcomes are assessed using patient-reported outcome metrics (PROMs).
• Consensus on calculating minimum clinically important differences (MCIDs) for PROMs in CSM is lacking.
• Optimal MCIDs are crucial for interpreting treatment efficacy and guiding clinical decisions.

Purpose of the Study:

• To identify and define the optimal MCIDs for commonly used PROMs in patients with CSM.
• To establish reliable benchmarks for assessing treatment impact in CSM.

Main Methods:

• Retrospective analysis of the Quality Outcomes Database SpineCORe Study Group CSM cohort.
• Collected baseline, 3-month, and 24-month PROM data for Neck Disability Index (NDI), EQ-5D, mJOA score, and neck/arm pain NRS.
• Calculated MCIDs using validated techniques and compared methods via area under the curve (AUC) with patient satisfaction as an anchor.

Main Results:

• A ≥30% improvement from baseline was the optimal MCID for NDI and neck/arm NRS.
• Absolute numeric cutoffs (0.065 at 3 months; 0.149 at 24 months) were superior for EQ-5D.
• A severity-adjusted MCID outperformed other methods for the mJOA score (AUC 0.67 at 24 months).
• MCIDs were achieved by 52-63% of patients at 24 months across PROMs.

Conclusions:

• Optimal MCIDs for key PROMs in CSM were defined using the SpineCORe dataset.
• A ≥30% improvement is recommended for NDI and NRS, an absolute numeric cutoff for EQ-5D, and a severity-adjusted MCID for mJOA score.
• These redefined benchmarks enhance the interpretation of treatment effects and support informed care decisions for CSM patients.