Letter to the Editor: There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review

Limitations of Minimal Clinically Important Difference Estimates and Potential Alternatives

“…Our concerns are centered on the methods utilized to calculate MCIDs. We have made similar arguments in prior publications 7-10 and elaborate on our concerns in the present review. Herein, we present the limitations of MCIDs that, in our opinion, justify why they should not be routinely utilized by orthopaedic surgeons.…”

Reply to the Letter to the Editor: There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review

“…The second concern raised was related to the impact of the abbreviated quote by Jaeschke et al [5] that we used, as abbreviating that quote removed some context when applying MCIDs to varying populations. As the authors of the letter to the editor detailed [7], this is a flaw in the application of MCID as a single decision-making tool. We address the limitations of utilizing MCID; Bernstein et al [1] noted that the MCID, the patient-acceptable symptom state (PASS), and the substantial clinical benefit (SCB) should not be considered mutually exclusive metrics.…”

“…We thank Dr. Riddle and Dr. Dumenci for their insightful response [7] to our systematic reviews about the use of minimum clinically important differences (MCID) for patient-reported outcome measures (PROMs) after hip and knee arthroplasty [3,4]. Much of their response focuses on inherent problems with the PROMS that have been commonly used in orthopaedic surgery, the limitations of MCIDs, as well as potential alternatives for determining meaningful changes.…”

“…We again thank Dr. Riddle and Dr. Dumenci for their letter to the editor [7] underscoring the limitations of the MCID value. We value feedback on our work and hope our response provides clarity of purpose, reiterates our acknowledgement of the shortcomings of MCID values, and promotes further research of improved measures of effect size, such as the two alternatives proposed by Drs.…”

“…We value feedback on our work and hope our response provides clarity of purpose, reiterates our acknowledgement of the shortcomings of MCID values, and promotes further research of improved measures of effect size, such as the two alternatives proposed by Drs. Riddle and Dumenci [7]: the discrete latent variable framework and the smallest worthwhile effect.…”