Time Required to Achieve Minimal Clinically Important Difference and Substantial Clinical Benefit After Arthroscopic Treatment of Femoroacetabular Impingement

Nwachukwu, Benedict U.; Chang, Brenda; Adjei, Joshua; Schairer, William W.; Ranawat, Anil S.; Kelly, Bryan T.; Nawabi, Danyal H.

doi:10.1177/0363546518786480

Cited by 103 publications

(105 citation statements)

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“…1 Clinical researchers are beginning to explore the role and psychometric properties of outcome measures such as minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). [2][3][4][5][6][7][8] Specifically, within the field of hip preservation surgery, a lot of attention has been paid to defining and understanding these clinical measures. In the study by Kivlan, Martin, Christoforetti, Wolff, Nho, Salvo, Ellis, Van Thiel, Matsuda, and Carreira 9 entitled "The Patient Acceptable Symptomatic State of the 12-Item International Hip Outcome Tool at 1-Year Follow-Up of Hip-Preservation Surgery," the authors sought to determine the PASS for the iHOT-12.…”

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confidence: 99%

“…Based on this delineation, prior work has proposed that MCID be considered a minimum target and lower bound of outcome improvement and SCB be considered the upper bound and optimal target. 2,5 Based on this definition, the authors misclassify SCB by stating: "The SCB differs from the PASS score in that it represents a change in score that distinguishes a subject as feeling 'normal' versus 'abnormal.'" I contend that SCB is not normal and represents an excellent (THE best) outcome.…”

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confidence: 99%

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Editorial Commentary: PASSing the Test Versus Acing It: Understanding Clinically Significant Outcome Improvement in Arthroscopic Hip Surgery

Nwachukwu

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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There is increasing interest in defining clinically significant outcome after orthopaedic procedures, and the field of hip preservation surgery is leading the way. Minimal clinically important difference, patient acceptable symptomatic state (PASS), and substantial clinical benefit have been established as important measures of clinically significant outcome. The International Hip Outcome Tool 12-question subset, one of the newer hip-specific measures, is being increasingly used. The 12-item version may prove popular among investigators given its decreased questionnaire burden. There still remain opportunities in future work to standardize how we analyze, interpret, and report clinically significant outcome. Specifically, an anchor-based method for calculating PASS may provide a more accurate representation of PASS score for arthroscopic hip surgery patients.

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Editorial Commentary: PASSing the Test Versus Acing It: Understanding Clinically Significant Outcome Improvement in Arthroscopic Hip Surgery

Nwachukwu

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The previously reported MCID using the mean change method for the mHHS was 8, 18 and a net change of 11.31 was reported as slightly improved by Nwachukwu et al 29 When we considered the mean change in PROM scores in the current study to represent the MCID, we found a change of 15.2 for the mHHS and 20.7 for the SF-36. Given that our cohort consisted of all competitive athletes, a higher value for the MCID might have been expected; however, as the preoperative baseline PROM scores were generally much higher than in similar nonathletic cohorts, 3,9,28,30,39 the scope for the increase in PROM scores was also lower.…”

Section: Discussionmentioning

confidence: 91%

“…This limitation in the MCID has previously been reported Terwee et al 38 reported 5 MCID values for the physical function subscale of the WOMAC when using 5 different MCID methods on the same study population. Clinically significant outcome improvement may continue beyond 2 years postoperatively, 28 and as such, establishing MCID standards at this time point may be more valuable.…”

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confidence: 99%

Defining the Minimal Clinically Important Difference in Athletes Undergoing Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The Percentage of Possible Improvement

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Filan

2020

Orthopaedic Journal of Sports Medicine

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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.

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“…While 67% of individuals reported MIC of more than ten points at 6-months post arthroscopy, the average iHOT33 score of 60/100 did not reflect optimal hip function. This trend of recovery as measured by PROMs has become widely reported [58,78,127,178,202,219] and may be at odds with patient expectations. The extent of likely recovery and the time taken to achieve should be more widely advertised to individuals considering arthroscopy to improve their hip pain and symptoms.…”

Section: Part D: Overall Discussion and Thesis Conclusion __________mentioning

confidence: 98%

Clinical predictors of outcome following hip arthroscopy

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Intra-articular hip pathology, including femoro-acetabular impingement syndrome (FAIS), is a cause of hip and groin pain in otherwise healthy young adults. While arthroscopic surgery in the hip joint has historically lagged behind its counterparts in the shoulder and knee, there has recently been a rapid evolution of the management of hip injuries in the young, active population utilizing hip arthroscopic techniques which has improved understanding of mechanical hip pathology. The aims of this thesis were to; investigate the clinical presentation of individuals scheduled to undergo hip arthroscopy; assess and report pre-operative deficits in hip strength, range of movement (ROM) and dynamic balance; determine the changes that occur post surgery, and; identify potentially modifiable predictors of outcome post arthroscopy.A review of literature revealed that there is limited evidence that those with FAI syndrome have reduced hip abduction and flexion ROM compared to healthy matched controls. There were no differences in hip adduction or extension ROM, and conflicting results for external rotation and internal rotation ROM. However, people with symptomatic FAIS demonstrated deficits in hip muscle strength and reduced dynamic balance on one leg when compared to controls. For hip joint ROM, there were no significant within-group differences between pre and post intervention time points while hip muscle strength improved significantly from pre to post-hip arthroscopy in a single case series.In people undergoing hip arthroscopy, severe femoral head chondropathy, large labral tears, along with a high prevalence of labral pathology and acetabular chondropathy, were relatively common findings. Severe femoral head chondropathy and large labral tears were most associated with patient related outcomes (PROs), however, at best only explained 22% of the variability. Individuals with hip pain and severe scores in the International Hip Outcome Tool (iHOT33) subscale of symptoms and functional limitations presented with significantly lesser hip muscle strength and hip flexion ROM when compared to individuals with moderate or mild scores. Individuals scheduled for arthroscopic hip surgery were also significantly weaker, had less hip mobility and reduced dynamic balance compared to healthy matched controls. In the hip pain population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction specific manner. The clinical significance of these findings may assist therapists in providing targeted rehabilitation programs for people with FAIS and chondrolabral hip pain to improve hip strength and ROM, help reduce symptoms and to improve function. 3 By three months post arthroscopy to address bony morphology and/or chondrolabral pathology, all directions of hip strength (with the exception of adduction squeeze in crook lying and flexion) and hip flexion ROM were significantly improved. While by six months post arthroscopy, strength in all directions, and flexion and rotation ROM were signifi...

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Time Required to Achieve Minimal Clinically Important Difference and Substantial Clinical Benefit After Arthroscopic Treatment of Femoroacetabular Impingement

Cited by 103 publications

References 17 publications

Editorial Commentary: PASSing the Test Versus Acing It: Understanding Clinically Significant Outcome Improvement in Arthroscopic Hip Surgery

Editorial Commentary: PASSing the Test Versus Acing It: Understanding Clinically Significant Outcome Improvement in Arthroscopic Hip Surgery

Defining the Minimal Clinically Important Difference in Athletes Undergoing Arthroscopic Correction of Sports-Related Femoroacetabular Impingement: The Percentage of Possible Improvement

Clinical predictors of outcome following hip arthroscopy

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