Related Experiment Video
Updated: Aug 5, 2026
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Determining the minimal important change in patient reported outcomes for carpal tunnel syndrome
Alex H S Harris1,2, Kristen Davis-Lopez2, Andrea K Finlay1
1Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California, USA.
Background:
Patient reported outcome measures (PROMs) can be used to quantify responses to treatment and for quality measurement purposes. However, the clinical importance of a given change in a PROM score is hard to interpret. The minimal important change (MIC) is the smallest change in score that patients consider important.
Objective:
To estimate MICs for three PROMs at 3- and 9-month follow-ups for a large five-institution sample of patients with carpal tunnel syndrome.
Design:
Cohort study.
Setting:
Two university, two Veterans Affairs, and one community nonprofit health care systems.
Patients:
Patients receiving initial consultation with a hand surgeon for carpal tunnel syndrome.
Measures And Methods:
Patients completed baseline, 3-month, and 9-month PROMs: the Boston Carpal Tunnel Questionnaire Symptom (BCTQ-SS) and Functioning (BCTQ-FN) Scales, and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scale. Anchor-based methods and Youden J-statistics were used to find the optimal MIC cut points that maximized sensitivity and specificity for patients being satisfied with the outcome of treatment.
Results:
Six hundred thirty-five patients completed the baseline PROMs, and 551 (87%) and 516 (81%) completed the 3- and 9-month PROMs, respectively. The percentage of patients who were at least somewhat satisfied with the results of treatment differed between the carpal tunnel release and nonoperative subgroups (91% vs. 67% at 9 months), as did the MIC estimates. At 9 months, 295 of 326 (91%) of carpal tunnel release patients were satisfied with the results of treatment, with MICs of 0.81, 0.66, and 15.7 for the BCTQ-SS, BCTQ-FN, and QDASH, respectively. We also produced MICs for the 3-month assessment, the nonoperative, and overall samples.
Conclusions:
These MIC estimates can be used in clinics or research to gauge response to treatment and used in the design of PROM-based quality measures.
Insights
This study determined the minimal important change (MIC) for patient-reported outcome measures (PROMs) in carpal tunnel syndrome patients. These MIC estimates help interpret treatment effectiveness and inform quality measures.
Area of Science:
- Orthopedics
- Health Outcomes Research
- Clinical Epidemiology
Background:
- Patient-reported outcome measures (PROMs) are crucial for assessing treatment response and quality.
- Interpreting the clinical significance of PROM score changes can be challenging.
- The minimal important change (MIC) quantifies the smallest score alteration patients deem significant.
Purpose of the Study:
- To estimate MICs for three PROMs at 3- and 9-month follow-ups.
- To analyze data from a large, multi-institution sample of carpal tunnel syndrome (CTS) patients.
- To provide benchmarks for assessing treatment outcomes in CTS.
Main Methods:
- A cohort study design was employed across five healthcare systems.
- Patients with carpal tunnel syndrome completed the Boston Carpal Tunnel Questionnaire (BCTQ) Symptom and Functioning Scales, and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scale.
- Anchor-based methods and Youden J-statistics were used to determine MICs based on patient satisfaction.
Main Results:
- A total of 635 patients completed baseline PROMs, with high follow-up rates at 3 and 9 months.
- Significant differences in satisfaction and MICs were observed between carpal tunnel release and nonoperative groups.
- At 9 months, MICs for carpal tunnel release patients were 0.81 (BCTQ-SS), 0.66 (BCTQ-FN), and 15.7 (QDASH).
Conclusions:
- The estimated MIC values provide a basis for interpreting treatment outcomes in clinical practice and research.
- These MICs can aid in the development and refinement of PROM-based quality measures for carpal tunnel syndrome.
- The findings support the use of PROMs with established MICs for evaluating treatment efficacy.
