Comparing improvement ratings and minimal clinically important difference values between patients and physical...

Area of Science:

• Orthopedics
• Physical Therapy
• Rehabilitation Medicine

Background:

• Minimal clinically important difference (MCID) is typically defined by patient-reported outcomes.
• Clinician judgments also inform MCID, but patient and physical therapist (PT) perspectives may diverge.
• Alignment between patient and PT-derived MCID values for lower extremity function remains unclear.

Purpose of the Study:

• To assess agreement in perceived improvement between patients and PTs.
• To compare MCID values for the Simplified Chinese Lower Extremity Functional Scale (SC-LEFS) based on patient and PT ratings.
• To evaluate the SC-LEFS's ability to detect meaningful change from both perspectives.

Main Methods:

• 763 patients (18-50 years) with lower extremity injuries completed the SC-LEFS pre- and post-4-week physical therapy.
• Patients and PTs independently rated improvement using a 7-point Global Rating of Change (GROC) scale.
• Receiver operating characteristic (ROC) curve analysis determined SC-LEFS MCID values differentiating 'improved' from 'not improved' groups for both patient and PT ratings.

Main Results:

• Substantial agreement was observed between patient and PT improvement ratings (kappa = 0.8).
• The SC-LEFS MCID was 9.5 for both patient and PT ratings.
• Sensitivity and specificity for the MCID ranged from 0.66 to 0.72, with an area under the curve (AUC) of 0.74 for both rating groups.

Conclusions:

• Patients and PTs demonstrated significant agreement in assessing functional improvement after 4 weeks of physical therapy.
• The SC-LEFS provides consistent MCID thresholds for detecting meaningful change, regardless of whether ratings are provided by patients or PTs.
• These findings support the SC-LEFS as a reliable tool for evaluating treatment outcomes in lower extremity injuries from both patient and clinician viewpoints.