Reported Minimal Clinically Important Differences for Patient-Reported Outcome Measures in Hand and Upper-Extremity...

In hand and upper-extremity surgery, there are many patient-reported outcome measures (PROMs) used to quantify symptom severity and track patient progress. However, there remains variability and uncertainty regarding the true or most appropriate minimal clinically important difference (MCID) values for each. This systematic review summarized the reported MCIDs for the most commonly used outcome instruments in hand and upper-extremity surgery.

The published literature was searched using strategies designed by a medical librarian for the concepts of MCID; the Boston Carpal Tunnel Questionnaire; the Disabilities of the Arm, Shoulder, and Hand Score (DASH); the Michigan Hand Outcomes Questionnaire; carpel tunnel syndrome; and other hand/upper limb disorders with related synonyms. These strategies were executed in Embase, Ovid-Medline All, CINAHL Plus, Scopus, and Web of Science from database inception. Studies retrieved from the database literature search were imported to Endnote. Any duplicate citations were identified and removed. The remaining citations were imported to Covidence screening software for further screening analysis.

In total, 25 studies published from 1998 to 2025 were included in final data extraction and analysis. Among these, 9 (36.0%) reported the MCID value for BCTQ, 4 (16.0%) reported the MCID value for the MHQ and DASH, and 12 (48.0%) reported the MCID value for the Quick Disabilities of the Arm, Shoulder, and Hand.

This comprehensive systematic review summarized the reported MCIDs for the Boston Carpal Tunnel Questionnaire, DASH, Quick Disabilities of the Arm, Shoulder, and Hand, and Michigan Hand Questionnaire, all of which are commonly used hand and upper-extremity PROMs. Reported MCIDs for a given PROM can vary not only with the population or diagnosis of patients included but also with the methods used to calculate meaningful change in these patients.

This systematic review reports the MCIDs for common hand and upper-extremity outcome measures, providing surgeons with reference values to interpret patient-reported changes, while also demonstrating variability in MCID based on diagnosis and methodology. This can help distinguish meaningful improvement for different clinical and patient settings in addition to aid design of studies with clinically relevant end points in upper-extremity surgery.