Related Experiment Video
Updated: Aug 5, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Defining the Minimal Clinically Important Difference (MCID), Patient Acceptable Symptom State (PASS), and Maximal
Ashley E Disantis1,2, Tom Ellis3, Robert Kollmorgen4
1Department of Physical Therapy UPMC Childrens Hospital of Pittsburgh.
Background:
The International Hip Outcome Tool 12 (iHOT-12) is commonly utilized to track outcomes in individuals with acetabular dysplasia (AD). Clinically important outcome values (CIOVs) of the iHOT-12 in individuals with AD are not yet defined.
Purpose:
To define the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) change score, absolute PASS threshold, and maximal outcome improvement (MOI) value for the iHOT-12 in individuals undergoing physiotherapy (PT) for AD.
Study Design:
Prospective cohort; psychometric property analysis.
Methods:
This prospective study included individuals aged 10-35 years with a clinical and radiographic diagnosis of AD who were referred for conservative management at two centers between December 2023 and February 2025. At baseline assessment and after 8-10 weeks of PT, individuals completed the iHOT-12. At 8-10-week follow-up, individuals also completed three anchor questions on satisfaction and function. The MCID was calculated utilizing 0.5 times the standard deviation of baseline iHOT-12 scores. Receiver operator curve analysis was utilized to determine the PASS change score, absolute PASS threshold, and MOI value.
Results:
Forty-five patients (42 females, mean age 16.5 + 7.8) met the inclusion criteria. After 8-10 weeks of PT (mean follow-up time = 69 days), 25 (55.6%) participants were in the "improved" group and 20 (44.4%) were in the "not improved" group. The MCID was 8.5 points. A PASS change score of 15.2 was calculated for individuals who were satisfied with high sensitivity (.77) and specificity (.78) with an AUC = .76 (95% CI: .59-.93). An absolute PASS iHOT-12 threshold score of 62 (sensitivity = .62, specificity = .87) identified those who were satisfied with their hip function after a trial of PT with an AUC = .82 (95% CI: .67-.97). An MOI threshold of 22.9% was also calculated with high sensitivity (.69) and specificity (.88) with an AUC = .78 (95% CI: .61-.95).
Conclusion:
This study defines MCID, PASS change score, absolute PASS threshold, and MOI threshold for the iHOT-12 in patients with AD after 8-10 weeks of PT. While most individuals reported improvement in symptoms, only half of individuals were satisfied with their current level of function.
Level Of Evidence:
Level 2.
