PMID- 36404574
OWN - NLM
STAT- MEDLINE
DCOM- 20230124
LR  - 20230201
IS  - 1878-5921 (Electronic)
IS  - 0895-4356 (Linking)
VI  - 152
DP  - 2022 Dec
TI  - The smallest worthwhile effect is superior to the MCID for estimating acceptable 
      benefits of knee arthroplasty.
PG  - 201-208
LID - S0895-4356(22)00269-4 [pii]
LID - 10.1016/j.jclinepi.2022.10.019 [doi]
AB  - BACKGROUND AND OBJECTIVES: Traditionally, the minimal clinically important 
      difference (MCID) is used to judge the meaningfulness of outcomes in total knee 
      arthroplasty (TKA). However, MCID estimates do not consider patient costs, 
      potential side effects, and inconveniences. MCIDs vary substantially across TKA 
      studies and have several conceptual and psychometric problems. A more 
      scientifically sound alternative for estimating benefits patients expect TKA is 
      the smallest worthwhile effect (SWE), measured with the benefit-harm trade-off 
      method. METHODS: We recruited 121 participants and followed them for 6 months 
      after surgery. All participants completed Knee Injury and Osteoarthritis Score 
      (KOOS) Pain and Function, and underwent an interview using the benefit-harm 
      trade-off method. RESULTS: The absolute SWE at the 50th percentile (approximating 
      the average patient) was 31 points KOOS Pain improvement and 28 points for KOOS 
      Function, daily living. Construct validity was supported with strong associations 
      between meeting SWE (yes or no) and satisfaction with 6-month outcome (yes or no) 
      using Pearson Chi Square (24.5, P < 0.001). CONCLUSION: Current MCID-based 
      methods for interpreting KOOS change scores have flaws while the SWE method is 
      conceptually superior. We determined the SWE of TKA that would justify the costs, 
      risks, and inconveniences of surgery. SWE estimates suggest that patients expect 
      a substantially greater change in KOOS scores than would be expected using MCID 
      estimates. Clinicians can use SWE estimates when discussing likely outcomes and 
      potential TKA benefits and risks with their patients.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Henderson, Nancy
AU  - Henderson N
AD  - Assistant Professor, Department of Rehabilitation Sciences, Georgia Southern 
      University- Armstrong campus, Savannah, GA, USA.
FAU - Riddle, Daniel L
AU  - Riddle DL
AD  - Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia 
      Commonwealth University, 900 East Leigh Street, Room 4:100, Richmond, VA, USA. 
      Electronic address: dlriddle@vcu.edu.
LA  - eng
PT  - Journal Article
DEP - 20221028
PL  - United States
TA  - J Clin Epidemiol
JT  - Journal of clinical epidemiology
JID - 8801383
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Knee
MH  - Treatment Outcome
MH  - Minimal Clinically Important Difference
MH  - Knee Joint/surgery
MH  - *Osteoarthritis, Knee/surgery
MH  - Pain
OTO - NOTNLM
OT  - Arthroplasty
OT  - Benefit
OT  - Knee
OT  - MCID
OT  - Outcome
OT  - Risk
EDAT- 2022/11/22 06:00
MHDA- 2023/01/25 06:00
CRDT- 2022/11/21 01:25
PHST- 2022/08/12 00:00 [received]
PHST- 2022/10/05 00:00 [revised]
PHST- 2022/10/21 00:00 [accepted]
PHST- 2022/11/22 06:00 [pubmed]
PHST- 2023/01/25 06:00 [medline]
PHST- 2022/11/21 01:25 [entrez]
AID - S0895-4356(22)00269-4 [pii]
AID - 10.1016/j.jclinepi.2022.10.019 [doi]
PST - ppublish
SO  - J Clin Epidemiol. 2022 Dec;152:201-208. doi: 10.1016/j.jclinepi.2022.10.019. Epub 
      2022 Oct 28.