PMID- 36398323
OWN - NLM
STAT- MEDLINE
DCOM- 20230322
LR  - 20240402
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Print)
IS  - 0009-921X (Linking)
VI  - 481
IP  - 4
DP  - 2023 Apr 1
TI  - Discordance Abounds in Minimum Clinically Important Differences in THA: A 
      Systematic Review.
PG  - 702-714
LID - 10.1097/CORR.0000000000002434 [doi]
AB  - BACKGROUND: The minimum clinically important difference (MCID) is intended to 
      detect a change in a patient-reported outcome measure (PROM) large enough for a 
      patient to appreciate. Their growing use in orthopaedic research stems from the 
      necessity to identify a metric, other than the p value, to better assess the 
      effect size of an outcome. Yet, given that MCIDs are population-specific and that 
      there are multiple calculation methods, there is concern about inconsistencies. 
      Given the increasing use of MCIDs in total hip arthroplasty (THA) research, a 
      systematic review of calculated MCID values and their respective ranges, as well 
      as an assessment of their applications, is important to guide and encourage their 
      use as a critical measure of effect size in THA outcomes research. 
      QUESTIONS/PURPOSES: We systematically reviewed MCID calculations and reporting in 
      current THA research to answer the following: (1) What are the most-reported PROM 
      MCIDs in THA, and what is their range of values? (2) What proportion of studies 
      report anchor-based versus distribution-based MCID values? (3) What are the most 
      common methods by which anchor-based MCID values are derived? (4) What are the 
      most common derivation methods for distribution-based MCID values? (5) How do the 
      reported medians and corresponding ranges compare between calculation methods for 
      each PROM? METHODS: The EMBASE, MEDLINE, and PubMed databases were systematically 
      reviewed from inception through March 2022 for THA studies reporting an MCID 
      value for any PROMs. Two independent authors reviewed articles for inclusion. All 
      articles calculating new PROM MCID scores after primary THA were included for 
      data extraction and analysis. MCID values for each PROM, MCID calculation method, 
      number of patients, and study demographics were extracted from each article. In 
      total, 30 articles were included. There were 45 unique PROMs for which 242 MCIDs 
      were reported. These studies had a total of 1,000,874 patients with a median age 
      of 64 years and median BMI of 28.7 kg/m 2 . Women made up 55% of patients in the 
      total study population, and the median follow-up period was 12 months (range 0 to 
      77 months). The overall risk of bias was assessed as moderate using the modified 
      Methodological Index for Nonrandomized Studies criteria for comparative studies 
      (the mean score for comparative papers in this review was 18 of 24, with higher 
      scores representing better study quality) and noncomparative studies (for these, 
      the mean score was 10 of a possible 16 points, with higher scores representing 
      higher study quality). Calculated values were classified as anchor-based, 
      distribution-based, or not reported. MCID values for each PROM, MCID calculation 
      method, number of patients, and study demographics were extracted from each 
      study. Anchor-based and distribution-based MCIDs were compared for each unique 
      PROM using a Wilcoxon rank sum test, given the non-normal distribution of values. 
      RESULTS: The Oxford Hip Score (OHS) and the Hip Injury and Osteoarthritis Score 
      (HOOS) Pain and Quality of Life subscore MCIDs were the most frequently reported, 
      comprising 12% (29 of 242), 8% (20 of 242), and 8% (20 of 242), respectively. The 
      EuroQol VAS (EQ-VAS) was the next-most frequently reported (7% [17 of 242]) 
      followed by the EuroQol 5D (EQ-5D) (7% [16 of 242]). The median anchor-based 
      value for the OHS was 9 (IQR 8 to 11), while the median distribution-based value 
      was 6 (IQR 5 to 6). The median anchor-based MCID values for HOOS Pain and Quality 
      of Life were 33 (IQR 28 to 35) and 25 (14 to 27), respectively; the median 
      distribution-based values were 10 (IQR 9 to 10) and 13 (IQR 10 to 14), 
      respectively. Thirty percent (nine of 30) of studies used an anchor-based method 
      to calculate a new MCID, while 40% (12 of 30) used a distribution-based 
      technique. Thirty percent of studies (nine of 30) calculated MCID values using 
      both methods. For studies reporting an anchor-based calculation method, a 
      question assessing pain relief, satisfaction, or quality of life on a five-point 
      Likert scale was the most commonly used anchor (30% [eight of 27]), followed by a 
      receiver operating characteristic curve estimation (22% [six of 27]). For studies 
      using distribution-based calculations, the most common method was one-half the 
      standard deviation of the difference between preoperative and postoperative PROM 
      scores (46% [12 of 26]). Most reported median MCID values (nine of 14) did not 
      differ by calculation method for each unique PROM (p > 0.05). The OHS, HOOS JR, 
      and HOOS Function, Symptoms, and Activities of Daily Living subscores all varied 
      by calculation method, because each anchor-based value was larger than its 
      respective distribution-based value. CONCLUSION: We found that MCIDs do not vary 
      very much by calculation method across most outcome measurement tools. 
      Additionally, there are consistencies in MCID calculation methods, because most 
      authors used an anchor question with a Likert scale for the anchor-based approach 
      or used one-half the standard deviation of preoperative and postoperative PROM 
      score differences for the distribution-based approach. For some of the most 
      frequently reported MCIDs, however, anchor-based values tend to be larger than 
      distribution-based values for their respective PROMs. CLINICAL RELEVANCE: We 
      recommend using a 9-point increase as the MCID for the OHS, consistent with the 
      median reported anchor-based value derived from several high-quality studies with 
      large patient groups that used anchor-based approaches for MCID calculations, 
      which we believe are most appropriate for most applications in clinical research. 
      Likewise, we recommend using the anchor-based 33-point and 25-point MCIDs for the 
      HOOS Pain and Quality of Life subscores, respectively. We encourage using 
      anchor-based MCID values of WOMAC Pain, Function, and Stiffness subscores, which 
      were 29, 26, and 30, respectively.
CI  - Copyright (c) 2022 by the Association of Bone and Joint Surgeons.
FAU - Deckey, David G
AU  - Deckey DG
AUID- ORCID: 0000-0001-7374-5001
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
FAU - Verhey, Jens T
AU  - Verhey JT
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
FAU - Christopher, Zachary K
AU  - Christopher ZK
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
FAU - Gerhart, Coltin R B
AU  - Gerhart CRB
AD  - Texas Christian University School of Medicine, Fort Worth, TX, USA.
FAU - Clarke, Henry D
AU  - Clarke HD
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
FAU - Spangehl, Mark J
AU  - Spangehl MJ
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
FAU - Bingham, Joshua S
AU  - Bingham JS
AD  - Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20221019
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - IM
CIN - Clin Orthop Relat Res. 2023 Apr 1;481(4):715-716. PMID: 36735583
CIN - Clin Orthop Relat Res. 2023 Apr 1;481(4):841-842. PMID: 36827486
MH  - Humans
MH  - Female
MH  - Middle Aged
MH  - Male
MH  - *Arthroplasty, Replacement, Hip/adverse effects
MH  - Treatment Outcome
MH  - Quality of Life
MH  - Activities of Daily Living
MH  - Pain
MH  - Patient Reported Outcome Measures
MH  - Minimal Clinically Important Difference
PMC - PMC10013655
COIS- Each author certifies that there are no funding or commercial associations 
      (consultancies, stock ownership, equity interest, patent/licensing arrangements, 
      etc.) that might pose a conflict of interest in connection with the submitted 
      article related to the author or any immediate family members. All ICMJE Conflict 
      of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) 
      editors and board members are on file with the publication and can be viewed on 
      request.
EDAT- 2022/11/19 06:00
MHDA- 2023/03/23 06:00
PMCR- 2024/04/01
CRDT- 2022/11/18 02:14
PHST- 2022/05/23 00:00 [received]
PHST- 2022/09/08 00:00 [accepted]
PHST- 2022/11/19 06:00 [pubmed]
PHST- 2023/03/23 06:00 [medline]
PHST- 2022/11/18 02:14 [entrez]
PHST- 2024/04/01 00:00 [pmc-release]
AID - 00003086-202304000-00014 [pii]
AID - CORR-D-22-00653 [pii]
AID - 10.1097/CORR.0000000000002434 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2023 Apr 1;481(4):702-714. doi: 
      10.1097/CORR.0000000000002434. Epub 2022 Oct 19.