PMID- 30179897 OWN - NLM STAT- MEDLINE DCOM- 20191111 LR - 20210824 IS - 2329-9185 (Electronic) IS - 2329-9185 (Linking) VI - 6 IP - 9 DP - 2018 Sep TI - Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part I: Upper Extremity: A Systematic Review. PG - e1 LID - 10.2106/JBJS.RVW.17.00159 [doi] AB - BACKGROUND: The minimum clinically important difference (MCID) attempts to define the patient's experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of MCID calculation. Subsequently, we hope that the information presented here will help practitioners to better understand the MCID and to serve as a guide for future efforts to calculate the MCID. The first part of this review focuses on the upper-extremity orthopaedic literature. Part II will focus on the lower-extremity orthopaedic literature. METHODS: A review was conducted of the 2014 to 2016 publications in The Journal of Arthroplasty, The Journal of Bone & Joint Surgery, The American Journal of Sports Medicine, Foot & Ankle International, Journal of Orthopaedic Trauma, Journal of Pediatric Orthopaedics, and Journal of Shoulder and Elbow Surgery. Only clinical science articles utilizing patient-reported outcome measure (PROM) scores were included in the analysis. A keyword search was then performed to identify articles that calculated or referenced the MCID. Articles were then further categorized into upper-extremity and lower-extremity publications. MCID utilization in the selected articles was subsequently characterized and recorded. RESULTS: The MCID was referenced in 129 (7.5%) of 1,709 clinical science articles that utilized PROMs: 52 (40.3%) of 129 were related to the upper extremity, 5 (9.6%) of 52 independently calculated MCID values, and 47 (90.4%) of 52 used previously published MCID values as a gauge of their own results. MCID values were considered or calculated for 16 PROMs; 12 of these were specific to the upper extremity. Six different methods were used to calculate the MCID. Calculated MCIDs had a wide range of values for the same PROM (e.g., 8 to 36 points for Constant-Murley scores and 6.4 to 17 points for American Shoulder and Elbow Surgeons [ASES] scores). CONCLUSIONS: Determining useful MCID values remains elusive and is compounded by the proliferation of PROMs in the field of orthopaedics. The fundamentals of MCID calculation methods should be critically evaluated. If necessary, these methods should be corrected or abandoned. Furthermore, the type of change intended to be measured should be clarified: beneficial, detrimental, or small or large changes. There should also be assurance that the calculation method actually measures the intended change. Finally, the measurement error should consistently be reported. CLINICAL RELEVANCE: The MCID is increasingly used as a measure of patients' improvement. However, the MCID does not yet adequately capture the clinical importance of patients' improvement. FAU - Copay, Anne G AU - Copay AG AUID- ORCID: 0000-0002-3179-2587 AD - SPIRITT Research, St. Louis, Missouri. FAU - Chung, Andrew S AU - Chung AS AUID- ORCID: 0000-0003-3942-9595 AD - Department of Orthopaedics, Mayo Clinic-Arizona, Phoenix, Arizona. FAU - Eyberg, Blake AU - Eyberg B AUID- ORCID: 0000-0002-9361-1964 AD - Orthopaedic Surgery Residency, University of Arizona College of Medicine, Phoenix, Arizona. FAU - Olmscheid, Neil AU - Olmscheid N AUID- ORCID: 0000-0002-3970-7850 AD - Orthopedic Surgery Residency, McLaren Greater Lansing, Michigan State University, Lansing, Michigan. FAU - Chutkan, Norman AU - Chutkan N AUID- ORCID: 0000-0001-7751-9095 AD - Orthopaedic Surgery Residency, University of Arizona College of Medicine, Phoenix, Arizona. FAU - Spangehl, Mark J AU - Spangehl MJ AUID- ORCID: 0000-0003-1090-9165 AD - Department of Orthopaedics, Mayo Clinic-Arizona, Phoenix, Arizona. LA - eng PT - Journal Article PT - Systematic Review PL - United States TA - JBJS Rev JT - JBJS reviews JID - 101674872 SB - IM MH - Adult MH - Arthroplasty, Replacement, Elbow/*trends MH - Arthroplasty, Replacement, Shoulder/*trends MH - Child MH - Female MH - Humans MH - Male MH - Minimal Clinically Important Difference MH - Orthopedics/*trends MH - Treatment Outcome MH - Upper Extremity/*surgery EDAT- 2018/09/05 06:00 MHDA- 2019/11/12 06:00 CRDT- 2018/09/05 06:00 PHST- 2018/09/05 06:00 [pubmed] PHST- 2019/11/12 06:00 [medline] PHST- 2018/09/05 06:00 [entrez] AID - 01874474-201809000-00002 [pii] AID - 10.2106/JBJS.RVW.17.00159 [doi] PST - ppublish SO - JBJS Rev. 2018 Sep;6(9):e1. doi: 10.2106/JBJS.RVW.17.00159.