PMID- 32030345
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240328
IS  - 2325-9671 (Print)
IS  - 2325-9671 (Electronic)
IS  - 2325-9671 (Linking)
VI  - 8
IP  - 1
DP  - 2020 Jan
TI  - Defining the Minimal Clinically Important Difference in Athletes Undergoing 
      Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The 
      Percentage of Possible Improvement.
PG  - 2325967119894747
LID - 10.1177/2325967119894747 [doi]
LID - 2325967119894747
AB  - BACKGROUND: Measures of clinically meaningful improvement in patient-reported 
      outcomes within orthopaedics are becoming a minimum requirement to establish the 
      success of an intervention. PURPOSE: To (1) define the minimal clinically 
      important difference (MCID) at 2 years postoperatively in competitive athletes 
      undergoing hip arthroscopic surgery for symptomatic, sports-related 
      femoroacetabular impingement utilizing existing anchor- and distribution-based 
      methods and (2) derive a measure of the MCID using the percentage of possible 
      improvement (POPI) method and compare against existing techniques. STUDY DESIGN: 
      Cohort study (diagnosis); Level of evidence, 2. METHODS: There were 2 objective 
      outcome measures-the modified Harris Hip Score (mHHS) and 36-Item Short Form 
      Health Survey (SF-36)-administered at baseline and 2 years postoperatively. 
      External anchor questions were used to determine the MCID through mean change, 
      mean difference, and receiver operating characteristic (ROC) techniques. 
      Distribution-based calculations consisted of 0.5 SD, effect size, and standard 
      error of measurement techniques. The POPI was calculated alongside each technique 
      as an achieved percentage change of maximum available improvement for each 
      athlete relative to the individual baseline score. The impact of the preoperative 
      baseline score on the MCID was assessed by assigning athletes to groups 
      determined by baseline percentiles. Statistical analysis was performed, with P < 
      .05 considered significant. RESULTS: There were 576 athletes (96% male; mean age, 
      25.9 +/- 5.7 years). The MCID score change (and POPI) for the mHHS and SF-36 ranged 
      from 2.4 to 16.7 (21.6%-63.6%) and from 3.3 to 24.9 (22.1%-57.4%), respectively. 
      The preoperative threshold value for achieving the ROC-determined MCID was 80.5 
      and 86.5 for the mHHS and 70.1 and 72.4 for the SF-36 for the patient-reported 
      outcome measure (PROM) score- and POPI-calculated MCID, respectively. Through the 
      commonly used mean change method, 40.0% (mHHS) and 42.4% (SF-36) of athletes were 
      unable to achieve the MCID because of high baseline scores and PROM ceiling 
      effects compared with 0% when the POPI technique was used. A highly significant 
      difference for the overall MCID was observed between preoperative baseline 
      percentile groups for the mHHS (P = .014) and SF-36 (P = .004) (improvement in 
      points), while there was no significant difference between groups for either the 
      mHHS (P = .487) or SF-36 (P = .417) using the POPI technique. CONCLUSION: The 
      MCID defined by an absolute value of improvement was unable to account for 
      postoperative progress in a large proportion of higher functioning athletes. The 
      POPI technique negated associated ceiling effects, was unrestricted by the 
      baseline score, and may be more appropriate in quantifying clinically important 
      improvement.
CI  - (c) The Author(s) 2020.
FAU - Carton, Patrick
AU  - Carton P
AD  - The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland.
AD  - UPMC Whitfield, Waterford, Ireland.
FAU - Filan, David
AU  - Filan D
AD  - The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland.
AD  - UPMC Whitfield, Waterford, Ireland.
LA  - eng
PT  - Journal Article
DEP - 20200123
PL  - United States
TA  - Orthop J Sports Med
JT  - Orthopaedic journal of sports medicine
JID - 101620522
PMC - PMC6978826
OTO - NOTNLM
OT  - MCID
OT  - athletes
OT  - femoroacetabular impingement
OT  - hip arthroscopic surgery
OT  - percentage of possible improvement
COIS- The authors declared that there are no conflicts of interest in the authorship 
      and publication of this contribution. AOSSM checks author disclosures against the 
      Open Payments Database (OPD). AOSSM has not conducted an independent 
      investigation on the OPD and disclaims any liability or responsibility relating 
      thereto.
EDAT- 2020/02/08 06:00
MHDA- 2020/02/08 06:01
PMCR- 2020/01/23
CRDT- 2020/02/08 06:00
PHST- 2019/09/17 00:00 [received]
PHST- 2019/09/20 00:00 [accepted]
PHST- 2020/02/08 06:00 [entrez]
PHST- 2020/02/08 06:00 [pubmed]
PHST- 2020/02/08 06:01 [medline]
PHST- 2020/01/23 00:00 [pmc-release]
AID - 10.1177_2325967119894747 [pii]
AID - 10.1177/2325967119894747 [doi]
PST - epublish
SO  - Orthop J Sports Med. 2020 Jan 23;8(1):2325967119894747. doi: 
      10.1177/2325967119894747. eCollection 2020 Jan.