PMID- 26040969
OWN - NLM
STAT- MEDLINE
DCOM- 20151203
LR  - 20181113
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Print)
IS  - 0009-921X (Linking)
VI  - 473
IP  - 10
DP  - 2015 Oct
TI  - The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation 
      Score for Patients With Distal Radius Fractures.
PG  - 3235-41
LID - 10.1007/s11999-015-4376-9 [doi]
AB  - BACKGROUND: The Patient-rated Wrist Evaluation (PRWE) is a commonly used 
      instrument in upper extremity surgery and in research. However, to recognize a 
      treatment effect expressed as a change in PRWE, it is important to be aware of 
      the minimum clinically important difference (MCID) and the minimum detectable 
      change (MDC). The MCID of an outcome tool like the PRWE is defined as the 
      smallest change in a score that is likely to be appreciated by a patient as an 
      important change, while the MDC is defined as the smallest amount of change that 
      can be detected by an outcome measure. A numerical change in score that is less 
      than the MCID, even when statistically significant, does not represent a true 
      clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have 
      not been determined in patients with distal radius fractures. QUESTIONS/PURPOSES: 
      We asked: (1) What is the MCID of the PRWE score for patients with distal radius 
      fractures? (2) What is the MDC of the PRWE? METHODS: Our prospective cohort study 
      included 102 patients with a distal radius fracture and a median age of 59 years 
      (interquartile range [IQR], 48-66 years). All patients completed the PRWE 
      questionnaire during each of two separate visits. At the second visit, patients 
      were asked to indicate the degree of clinical change they appreciated since the 
      previous visit. Accordingly, patients were categorized in two groups: (1) 
      minimally improved or (2) no change. The groups were used to anchor the changes 
      observed in the PRWE score to patients' perspectives of what was clinically 
      important. We determined the MCID using an anchor-based receiver operator 
      characteristic method. In this context, the change in the PRWE score was 
      considered a diagnostic test, and the anchor (minimally improved or no change as 
      noted by the patients from visit to visit) was the gold standard. The optimal 
      receiver operator characteristic cutoff point calculated with the Youden index 
      reflected the value of the MCID. RESULTS: In our study, the MCID of the PRWE was 
      11.5 points. The area under the curve was 0.54 (95% CI, 0.37-0.70) for the pain 
      subscale and 0.71 (95% CI, 0.57-0.85) for the function subscale. We determined 
      the MDC to be 11.0 points. CONCLUSIONS: We determined the MCID of the PRWE score 
      for patients with distal radius fractures using the anchor-based approach and 
      verified that the MDC of the PRWE was sufficiently small to detect our MCID. 
      CLINICAL RELEVANCE: We recommend using an improvement on the PRWE of more than 
      11.5 points as the smallest clinically relevant difference when evaluating the 
      effects of treatments and when performing sample-size calculations on studies of 
      distal radius fractures.
FAU - Walenkamp, Monique M J
AU  - Walenkamp MM
AD  - Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, 
      Amsterdam, The Netherlands, m.m.walenkamp@amc.nl.
FAU - de Muinck Keizer, Robert-Jan
AU  - de Muinck Keizer RJ
FAU - Goslings, J Carel
AU  - Goslings JC
FAU - Vos, Lara M
AU  - Vos LM
FAU - Rosenwasser, Melvin P
AU  - Rosenwasser MP
FAU - Schep, Niels W L
AU  - Schep NW
LA  - eng
PT  - Journal Article
DEP - 20150604
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - IM
EIN - Clin Orthop Relat Res. 2015 Sep;473(9):3063. PMID: 26155768
CIN - Clin Orthop Relat Res. 2015 Oct;473(10):3242-4. PMID: 26224290
MH  - Aged
MH  - *Diagnostic Self Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Outcome Assessment
MH  - Prospective Studies
MH  - Radius Fractures/*surgery
MH  - Wrist Joint
PMC - PMC4562929
EDAT- 2015/06/05 06:00
MHDA- 2015/12/15 06:00
PMCR- 2015/06/04
CRDT- 2015/06/05 06:00
PHST- 2015/02/17 00:00 [received]
PHST- 2015/05/21 00:00 [accepted]
PHST- 2015/06/05 06:00 [entrez]
PHST- 2015/06/05 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
PHST- 2015/06/04 00:00 [pmc-release]
AID - 4376 [pii]
AID - 10.1007/s11999-015-4376-9 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2015 Oct;473(10):3235-41. doi: 10.1007/s11999-015-4376-9. 
      Epub 2015 Jun 4.