Journal article
Minimal Important Clinical Difference Values Are Not Uniformly Valid in the Active Duty Military Population Recovering from Shoulder Surgery
Journal of shoulder and elbow surgery, Vol.33(11), pp.e596-e605
11/2024
DOI: 10.1016/j.jse.2024.02.044
PMID: 38614369
Abstract
There are multiple methods for calculating the minimal clinically important difference (MCID) threshold, and previous reports highlight heterogeneity and limitations of anchor-based and distribution-based analyses. The Warfighter Readiness Survey assesses the perception of a military population’s fitness to deploy and may be used as a functional index in anchor-based MCID calculations. The purpose of the current study in a physically demanding population undergoing shoulder surgery was to compare the yields of two different anchor-based methods of calculating MCID for a battery of PROMs, a standard receiver operator curve (ROC) -based MCIDs and baseline-adjusted ROC MCIDs.
All service members enrolled prospectively in a multicenter database with prior shoulder surgery that completed pre- and postoperative PROMs at a minimum of 12 months were included. The PROMs battery included Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons score (ASES), Patient Reported Outcome Management Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), and the Warfighter Readiness survey. Standard anchor-based and baseline-adjusted ROC MCIDs were employed to determine if the calculated MCIDs were both statistically and theoretically valid (95% confidence interval either completely negative or positive).
There were 117 patients (136 operations) identified, comprised of 83% males with a mean age of 35.7 ± 10.4 years and 47% arthroscopic labral repair/capsulorrhaphy. Using the standard, anchor-based ROC MCID calculation, the area under the curve (AUC) for SANE, ASES, PROMIS PF, and PROMIS PI were greater than 0.5 (statistically valid). For ASES, PROMIS PF, and PROMIS PI, the calculated MCID 95% CI all crossed 0 (theoretically invalid). Using the baseline-adjusted ROC MCID calculation, the MCID estimates for SANE, ASES, and PROMIS PI were both statistically and theoretically valid if the baseline score was less than 70.5, 69, and 65.7.
When MCIDs were calculated and anchored to the results of standard, anchor-based MCID, a standard ROC analysis did not yield statistically or theoretically valid results across a battery of PROMs commonly used to assess outcomes after shoulder surgery in the active duty military population. Conversely, a baseline-adjusted ROC method was more effective at discerning changes across a battery of PROMs among the same cohort.
Details
- Title: Subtitle
- Minimal Important Clinical Difference Values Are Not Uniformly Valid in the Active Duty Military Population Recovering from Shoulder Surgery
- Creators
- Andrew J. Sheean - San Antonio Military Medical CenterMatthew S. Tenan - Defense Health AgencyMikalyn T. DeFoor - San Antonio Military Medical CenterDaniel J. Cognetti - San Antonio Military Medical CenterAsheesh Bedi - Pittsburg State UniversityAlbert Lin - Pittsburg State UniversityTravis J. Dekker - United States Air Force AcademyIvan J. AntoshJames BaileyBrian T. BarlowCraig R. BottoniMatthew W. BradleyKenneth L. CameronWilliam E. DanerJonathan F. Dickens - Walter Reed National Military Medical CenterMichael A. DonohueJoseph W. GalvinEstephan J. GarciaShawn GeeChad A. HaleyAndrew P. HurvitzKelly KilcoyneJoseph T. LanziLance LeClereIan E. LeeLucas S. McDonaldKyong S. MinBrett D. OwensMark PallisJeanne C. PatzkowskiMatthew PosnerBenjamin K. PotterMatthew T. ProvencherDaniel RhonChristopher J. RoachRichard Judd RobinsMarina J. RodriguezMatthew R. SchmitzMark SlabaughJennifer L. SmithDaniel J. SongDavid T. StreetsDavid TennentJohn M. TokishChristopher J. TuckerScott C. WagnerRobert WaltzMatthew S. Tenan - Defense Health AgencyWilliam R. VolkMOTION Collaborative
- Resource Type
- Journal article
- Publication Details
- Journal of shoulder and elbow surgery, Vol.33(11), pp.e596-e605
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jse.2024.02.044
- PMID
- 38614369
- ISSN
- 1058-2746
- eISSN
- 1532-6500
- Language
- English
- Electronic publication date
- 04/11/2024
- Date published
- 11/2024
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984618496902771
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