PMID- 30179898
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 II: Lower Extremity: A Systematic Review.
PG  - e2
LID - 10.2106/JBJS.RVW.17.00160 [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 the MCID calculation, so as to help practitioners to understand and utilize 
      the MCID and to guide future efforts to calculate the MCID. In Part I of this 
      review, we sampled the orthopaedic literature in relation to the upper extremity. 
      In this part, Part II, of the review, we will focus on the lower-extremity 
      literature. METHODS: A review was conducted of the 2014 to 2016 MCID-related 
      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 measures (PROMs) were included in the analysis. A keyword search was then 
      performed to identify articles that used the MCID. Articles were then further 
      categorized into upper-extremity and lower-extremity publications. The MCID 
      utilization in the selected articles was characterized and was recorded. RESULTS: 
      The MCID was referenced in 129 (7.5%) of 1,709 clinical science articles that 
      utilized PROMs: 79 (61.2%) of the 129 articles were related to the lower 
      extremity; of these, 11 (13.9%) independently calculated the MCID values and 68 
      (86.1%) used previously published MCID values as a gauge of their own results. 
      The MCID values were calculated or were considered for 31 PROMs, of which 24 were 
      specific to the lower extremity. Eleven different methods were used to calculate 
      the MCID. The MCID had a wide range of values for the same questionnaires, for 
      instance, 5.8 to 31.3 points for the Western Ontario and McMaster Universities 
      Osteoarthritis Index (WOMAC). CONCLUSIONS: There are more than twice as many 
      PROMs for the lower extremity (24) than for the upper extremity (11), confirming 
      that the determination of useful MCID values is, in part, hampered by the 
      proliferation of PROMs in the field of orthopaedics. The difference between 
      significance and clinical importance needs to be further clarified. For instance, 
      the common use of determining sample size with the MCID and comparing group means 
      with the MCID implies that a significant result will also be clinically 
      important. Further, the study of the MCID would benefit from consensus agreement 
      on relevant terminology and the appropriate usage of the MCID determining 
      equations. CLINICAL RELEVANCE: MCID is increasingly used as a measure of 
      patients' improvement. However, 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 - Eyberg, Blake
AU  - Eyberg B
AUID- ORCID: 0000-0002-9361-1964
AD  - Orthopaedic Surgery Residency (B.E. and N.C.) and Phoenix Integrated Surgical 
      Residency (K.S.Z.), University of Arizona College of Medicine, Phoenix, Arizona.
FAU - Chung, Andrew S
AU  - Chung AS
AUID- ORCID: 0000-0003-3942-9595
AD  - Department of Orthopedics, Mayo Clinic-Arizona, Phoenix, Arizona.
FAU - Zurcher, Kenneth S
AU  - Zurcher KS
AUID- ORCID: 0000-0002-7758-2526
AD  - Orthopaedic Surgery Residency (B.E. and N.C.) and Phoenix Integrated Surgical 
      Residency (K.S.Z.), University of Arizona College of Medicine, Phoenix, Arizona.
FAU - Chutkan, Norman
AU  - Chutkan N
AUID- ORCID: 0000-0001-7751-9095
AD  - Orthopaedic Surgery Residency (B.E. and N.C.) and Phoenix Integrated Surgical 
      Residency (K.S.Z.), University of Arizona College of Medicine, Phoenix, Arizona.
FAU - Spangehl, Mark J
AU  - Spangehl MJ
AUID- ORCID: 0000-0003-1090-9165
AD  - Department of Orthopedics, 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, Hip/*trends
MH  - Arthroplasty, Replacement, Knee/*trends
MH  - Child
MH  - Female
MH  - Humans
MH  - Lower Extremity/*surgery
MH  - Male
MH  - Minimal Clinically Important Difference
MH  - Orthopedics/*trends
MH  - Treatment Outcome
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 - 01874474-201809000-00003 [pii]
AID - 10.2106/JBJS.RVW.17.00160 [doi]
PST - ppublish
SO  - JBJS Rev. 2018 Sep;6(9):e2. doi: 10.2106/JBJS.RVW.17.00160.