Understanding the minimum clinically important difference: a review of concepts and methods

Preoperative depression screening using PHQ-2 is associated with worse outcomes after ACL reconstruction

Purpose

To determine how screening positive for depression preoperatively can affect patient reported outcomes after anterior cruciate ligament reconstruction (ACLR).

Methods

Primary ACLR patients between May 2020-September 2022 with a PHQ-2 score prior to their surgery were retrospectively reviewed. Patients older than 13 years of age and with minimum 6-months of follow-up were included for analysis. Patients were categorized as PHQ(+) (PHQ-2 ≥2) or PHQ2(-) (PHQ-2 < 2). Demographics, preoperative and postoperative Patient Reported Outcome Information System (PROMIS) -Physical Function (PF) and Pain Interference (PI) scores, Patient Acceptable Symptomatic State (PASS), surgical clinical outcomes, and complications were collected and compared. Chi-square tests and independent t-tests were used for categorical and continuous variables, respectively.

Results

A total of 127 patients were analyzed, with 32 PHQ2(+) and 95 PHQ2(-). The PHQ2(+) group had a lower proportion responding "yes" to PASS preoperatively (6.5 % vs. 25.3 %, p = 0.03), at 9 months (47.4 % vs. 72.4 %, p = 0.05), and 12 months postoperatively (42.9 % vs 79.5 %, p = 0.009). PHQ2(+) reported worse PROMIS-PI scores preoperatively, at 6 months, and at 9 months. The PHQ2(+) group reported worse PROMIS-PF preoperatively, at 6 months, at and 12 months. The PHQ2(+) group had worse IKDC scores preoperatively at 9 months and at 12 months. Those screening positive for depression also demonstrated a higher incidence of postoperative complications (34.4 % vs. 9.5 %, p = 0.001) and reoperation rates (21.9 % vs. 4.2 %; p = 0.002).

Conclusion

A brief preoperative survey, such as the PHQ-2, can provide prognostic value for patient outcomes after ACLR.

Level of evidence

III-Retrospective cohort study.

The Minimal Clinically Important Difference for the Oswestry Disability Index Substantially Varies Based on Calculation Method: Implications to Value-Based Care

STUDY DESIGN

Retrospective study.

OBJECTIVE

Evaluate differences in the minimal clinically important difference (MCID) threshold value based on various acceptable statistical methods and how these differences may influence the interpretation of surgical benefit following elective 1- and 2-level lumbar fusion.

SUMMARY OF BACKGROUND DATA

The MCID is a statistically determined threshold value to evaluate if a patient has received benefit from a medical procedure. In the era of value-based medicine, the MCID has become increasingly important. However, there is substantial ambiguity surrounding the interpretation of this value, given that it can be influenced by both demographic and methodological factors.

METHODS

A total of 371 patients who underwent 1- or 2-level elective lumbar fusions between June 2021 and June 2023 were included in this study. All patients completed both their preoperative and 6-month postoperative Oswestry Disability Index (ODI), as well as 2 anchor questions concerning satisfaction with their surgical procedure. The MCID values were calculated using 16 accepted statistical methods, and the resulting MCID values were applied to the cohort to determine how many patients reached MCID by 6 months postfusion.

RESULTS

Results demonstrated significant variability in the MCID value. The average MCID value for all 16 methods was 10.5±7.0 points in the in the range (0.8 to 25). Distribution methods provided lower threshold MCID values but had greater variability while the Anchor methods resulted in higher threshold values but had lower variability. Depending on the method used 30% to 83% of the cohort reached MCID by 6 months.

CONCLUSION

The statistical method used to calculate the MCID resulted in significantly different threshold values and greatly affected the number of patients meeting MCID. The results demonstrates the complexity surrounding the interpretation of MCID values and calls into question the utility of a single statistically determined value to assess surgical success.

Development of a Risk Score to Aid With the Diagnosis of Infections After Spinal Cord Injury: Protocol for a Retrospective Cohort Study

BACKGROUND

Patients with spinal cord injury (SCI) who develop urinary tract infection (UTI) present differently than the non-SCI population. UTIs can cause loss of quality of life and even lead to life-threatening complications including urosepsis. Challenges in SCI management include distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB), which occurs often in patients with SCI, and the lack of standardization in UTI diagnosis in SCI.

OBJECTIVE

This study aims to set the foundation for the development of a risk score to improve diagnostic accuracy of UTI after SCI.

METHODS

This study will use data from the Veterans Health Administration Corporate Data Warehouse from national outpatient clinics. It will use 2 approaches: (1) a case-control study comparing frequency-matched healthy SCI cases (n=2000) with healthy non-SCI controls (n=2000) to establish a physiologic baseline for vital sign and lab measurements after SCI and (2) a retrospective cohort study of patients with SCI (n=400) to determine the positive predictive value of the baseline vital signs and lab measurements found in step 1, from which a threshold for clinically meaningful UTI after SCI will be established.

RESULTS

The study was funded in May 2023, and initial data extraction started in early 2024 and is expected to be completed in 2026. Data extraction, analysis, and results for aim 1 were completed as of manuscript submission. For aim 1, we hypothesize that SCI will be associated with lower temperature, heart rate, and systolic blood pressure when compared with non-SCI controls. SCI will also be associated with higher baseline levels of pyuria and peripheral white blood cells when compared with non-SCI controls. Data extraction for aim 2 will begin in year 1, and analysis and results will be completed in year 2. For aim 2, we hypothesize that pyuria, heart rate, and temperature measurements will have a high positive predictive value for clinically meaningful UTI.

CONCLUSIONS

Once complete, this study will be the basis for our future work developing a risk score to aid with the diagnosis of UTI after SCI and prevent antibiotic overuse in patients with SCI.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52610.

The Minimal Clinically Important Difference (MCID) for Total Joint Arthroplasty Outcome Measures Varies Substantially by Calculation Method

BACKGROUND

As the United States health-care system transitions to a value-based model, the minimal clinically important difference (MCID) has become an important metric for assessing perceived benefit in clinical settings. However, there is substantial ambiguity surrounding the MCID value because the calculation method used can lead to substantial changes in the clinical interpretation of surgical success.

METHODS

A total of 1,113 patients who underwent either total knee arthroplasty (TKA) or total hip arthroplasty (THA) between June 2021 and June 2023 and completed their patient-reported outcomes (the KOOS JR [Knee injury and Osteoarthritis Outcome Score for Joint Replacement] or HOOS JR [Hip disability and Osteoarthritis Outcome Score for Joint Replacement]) preoperatively and at 1 year postoperatively were reviewed for this study. The MCID values for the HOOS JR and KOOS JR were determined using 16 statistically appropriate methods, and the resulting MCID values were applied to the study group to assess how differences in methods changed the number of patients who met the MCID at 1 year postoperatively.

RESULTS

The study cohort consisted of 570 patients who underwent TKA and 543 who underwent THA. The overall cohort was 62.2% female, had a mean age of 69.3 ± 8.3 years, and was 92.3% Caucasian, 2.9% African American, and 4.8% other race (i.e., Asian, multiracial, or "other"). The MCID values varied substantially among the methods evaluated. The mean MCID was 11.5 ± 9.2 (range, 0.5 to 36.6) for the KOOS JR and 12.2 ± 8.9 (range, 0.6 to 34.3) for the HOOS JR. Distribution-based methods led to smaller but more variable MCID values, whereas anchor-based methods were noted to have larger but more consistent MCID values.

CONCLUSIONS

Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Establishing the Minimal Clinically Important Difference for the Wisconsin Stone Quality of Life Questionnaire Using Distribution- and Anchor-Based Methods

Purpose: The Wisconsin Stone Quality of Life (WISQOL) questionnaire is a survey-based tool that has been used to show worse health-related quality of life due to stone disease. The minimum clinically important difference threshold for determining whether changes in the WISQOL tool are meaningfully significant has not previously been estimated. Our study aimed to determine this threshold using distribution- and anchor-based methods. Materials and Methods: A retrospective single-center cohort of patients at a kidney stone clinic was administered the WISQOL questionnaire at initial and follow-up visits from January 2018 to November 2023. Baseline characteristics and WISQOL standardized scores and subdomain scores were recorded. Distribution-based estimates were calculated at the initial visit and at follow-up. Three anchor questions were used to create a global transition question scale. Cross-sectional, longitudinal within-group, and longitudinal between-group anchor-based estimates were calculated. Results: The cohort included 1197 individuals with both an initial clinic visit and a follow-up visit. The distribution-based minimum clinically important difference estimates ranged from 3.5 to 10.8. Cross-sectional anchor-based estimates ranged from 3.1 to 13.6. Within-group anchor-based estimates for improvement ranged from 8.5 to 10.3 and for deterioration ranged from 3.1 to 6.3. Between-group anchor-based estimates for improvement were 9.1 (adjusted confidence interval [CI]: 7.5-10.8) and for deterioration were 4.2 (adjusted CI: 2.3-6.1). Conclusions: A conservative threshold for clinical significance in total WISQOL score (standardized to scale of 0-100) is a difference of 9 for both improvement and deterioration. These findings can be used to further implement WISQOL in guiding clinical decision-making.

Large variability in minimal clinically important difference, substantial clinical benefit and patient acceptable symptom state values among literature investigating patellar stabilization surgery: A systematic review

PURPOSE

To investigate minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS) values for patient-reported outcome measures (PROMs) after patellar stabilization surgery for patellar instability. Secondary outcomes included to describe methods to calculate clinically significant outcomes (CSOs), and to report on the achievement of these metrics.

METHODS

On 31 July 2024, three databases were searched. Information on whether studies calculated MCID, SCB or PASS values or used previously established values was recorded. Data on study characteristics, CSO values, and the method of MCID quantification (e.g., distribution vs. anchor) were extracted.

RESULTS

A total of 17 articles with 1447 patients (1462 knees) were included. A total of 18 unique outcome measures were reported. Six out of 15 (40%), 2 out of 5 (40%), and zero studies used prior established values for MCID, SCB and PASS, respectively. MCID ranged widely (e.g., International Knee Documentation Committee [IKDC]: 5.6-20.5; Kujala Anterior Knee Pain Scale: 5.38-11.9 and Lysholm: 5.6-11.1). Fourteen out of 15 utilized a distribution-based method to calculate MCID, with only one study using an anchor-based method. SCB values ranged widely as well (e.g.

, IKDC

14.5-23.6; Knee Osteoarthritis and Outcome Score [KOOS] symptoms: 4.2-14.2 and KOOS activities of daily living [ADLs]: 6.5-25.7). Large variability was found among percentages of patients that achieved MCID values (e.g.

, IKDC

28%-98.6%, Kujala: 38%-100%, Lysholm: 44%-98.4% and Tegner: 84%-95%).

CONCLUSION

The significant heterogeneity in reported thresholds for MCID, SCB and PASS across studies highlights critical challenges in interpreting results after patellar stabilization surgery, specifically regarding what constitutes a clinically relevant outcome. MCID was the most commonly reported metric and calculated predominantly with distribution-based methods, with over half of the studies using previously established thresholds. PASS and SCB were widely underreported as well, suggesting a need for studies investigating patellar stabilization to prioritize the calculation of all three metrics, using anchor-based techniques.

LEVEL OF EVIDENCE

Level IV.

Bibliometric Analysis of Studies on The Rehabilitation of Disabled Athletes Through Visual Mapping

CONTEXT

The rehabilitation of disabled athletes is a critical area of research aimed at improving athletes' performance and well-being. This bibliometric analysis examines scientific studies related to the rehabilitation of disabled athletes, focusing on trends, authors, publications and interdisciplinary collaborations.

OBJECTIVE

This study seeks to provide quantitative and qualitative insights into the trends, interdisciplinary collaborations, and significant contributions in the rehabilitation of disabled athletes.

DESIGN

Bibliometric analysis of 660 scientific publications related to the rehabilitation of disabled athletes, from 1975 to 2023.

SETTING

The analysis reveals that research in this field is multidisciplinary, encompassing sports, medicine, rehabilitation and education. Studies focused on disabled athletes and their rehabilitation.

INTERVENTION

Rehabilitation plays a vital role in disabled athletes' lives, aiding in injury recovery and enhancing overall health and performance.

RESULTS

The United States leads in research output. Collaborative networks among authors are evident, indicating joint research efforts. Identification of research trends, prominent authors  Bartosz Molik and Natalia Morgulec-Adamowicz), collaborative networks and common keywords (e.g., adaptive sports, disability, rehabilitation). Keywords such as adaptive sports, disability and rehabilitation are frequently mentioned, reflecting the focus of research.

CONCLUSIONS

The rehabilitation of disabled athletes is a growing field with significant contributions from researchers worldwide. Collaborative efforts and interdisciplinary approaches are essential for advancing knowledge and improving the lives of disabled athletes.

Can the minimal clinically important difference (MCID) for the Oxford score, KOOS and its derivatives be identified in a French sample of total knee arthroplasties?

CONTEXT

To assess the effect of a surgical procedure on a patient, it is conventional to use clinical scores before and after the procedure, but it is increasingly common and recommended to weight the results of these scores with the notion of minimal clinically important difference ("MCID"). This MCID should be determined using either the data distribution method based on score variation, or the anchor method, which uses an external question to categorize the results. MCIDs vary from one population to another, and to our knowledge there has been no investigation in France for total knee arthroplasties (TKAs). We therefore conducted a prospective study on a population of TKAs in order to: 1) Define MCID in France on a population of TKAs for the Oxford score, KOOS (Knee injury and Osteoarthritis Outcome Score) and its derivatives, 2) Determine whether MCID for these scores in France is comparable to results in the literature.

HYPOTHESIS

Is the MCID for total knee arthroplasty in France comparable to other results in the literature?

MATERIAL AND METHOD

This was a prospective observational study in which 218 patients (85 men, 133 women) with a mean age of 72 years [27-90] who had undergone a primary TKA out of 300 initially included responded, before and after surgery, to the Oxford-12, KOOS and Forgotten Joint Score (FJS) questions (mean follow-up 24 months). MCID was calculated using the distribution method as well as the anchor method ("improvement 1 to 5" and "improvement yes or no").

RESULTS

At a mean follow-up of 24 months [18-36], the Oxford-12 score increased from 16 ± 8 [0-41] to 34 ± 11 [6-48] (p < 0.001), all components of the KOOS score were improved and the FJS at follow-up was 47 ± 32 [0-100]. For the anchor "improvement 1 to 5", there were 14 unimproved patients, 23 patients in identical condition and 179 patients improved by surgery. For the anchor "are you improved yes/no", there were 8 unimproved patients, 22 in identical condition and 187 surgically-improved patients. The mean MCID for all methods (anchor method and distribution) was 10 [7-13] for Oxford-12, 12 [12-12] for KOOS Symptom, 14 [12-17] for KOOS Pain, 12 [11-14] for KOOS Function, 14 [12-16] for KOOS Sport, 15 [15-16] for KOOS Quality of Life (QOL), 11 [10-12] for KOOS 12, 15 [12-18] for KOOS 12 Pa in. 12 [12-13] for KOOS 12 Function, 15 [15-15] for KOOS 12 QOL, 14 [13-14] for KOOS Physical Function Short-form (PS) and 14 [13-16] for KOOS Joint Replacement (JR).

DISCUSSION

The MCID for the Oxford-12, KOOS and its derivatives scores in a French population is comparable to that observed in other populations in the literature.

LEVEL OF EVIDENCE

IV; prospective study without control group.

Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS)

BACKGROUND

Complex Regional Pain Syndrome (CRPS) is a debilitating condition with profound physical and psychological impacts, necessitating comprehensive assessment tools for effective evaluation.

PURPOSE

This study aimed to validate the Persian version of the Hamilton Inventory for Complex Regional Pain Syndrome (HI-CRPS) and assess its reliability and validity in individuals diagnosed with CRPS.

STUDY DESIGN

A cross-sectional clinical measurement study evaluated the Persian version of HI-CRPS.

METHODS

A sample of 64 individuals diagnosed with CRPS from pain and hand surgeon clinics completed the Persian versions of the patient-reported (PR-HI-CRPS) and clinicians based (CB-HI-CRPS). Test-retest reliability was assessed after 1 week, and responsiveness was measured after 3 months. Baseline scores, ceiling effects, internal consistency (Cronbach's alpha), and construct validity (correlations with related measures) were examined. Effect sizes and standardized response means (SRM) were calculated to gauge responsiveness.

RESULTS

Baseline scores for PR-HI-CRPS and CB-HI-CRPS were 77.8 and 14.9, respectively. Around 18% of PR-HI-CRPS and 16% of CB-HI-CRPS respondents exhibited ceiling effects. Internal consistency for PR-HI-CRPS (Cronbach's alpha: 0.71-0.91) and CB-HI-CRPS (alpha: 0.90) was satisfactory. PR-HI-CRPS (ICC: 0.86) and CB-HI-CRPS (ICC: 0.97) showed robust test-retest reliability. Construct validity was confirmed by significant correlations between PR-HI-CRPS subscales and related measures (p < 0.01). Structural validity was confirmed by confirmatory factor analysis. PR-HI-CRPS displayed an effect size of 0.79 and a standardized response mean (SRM) of 0.88.

CONCLUSIONS

The Persian version of the HI-CRPS demonstrated satisfactory internal consistency, test-retest reliability, construct validity, and responsiveness. It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts.

Comparison of the European Foot and Ankle Score (EFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in patients with foot and ankle surgery

BACKGROUND

Both EFAS and AOFAS are questionnaires used in evaluating postoperative outcome of foot and ankle surgeries. The EFAS is a Patient Reported Outcome Measure (PROM), whereas the AOFAS also contains a physician reported subset and is the most commonly used questionnaire worldwide. Our study compared psychometric properties of both scores in patients with foot or ankle surgery.

METHODS

We compared validity and reliability of the EFAS and AOFAS questionnaires in 126 foot and ankle surgical patients. Internal consistency, test-retest reliability, floor and ceiling effects, construct validity, responsiveness and minimal important change were analyzed.

RESULTS

The AOFAS and EFAS show similar psychometric properties overall with the EFAS showing better internal consistency than the AOFAS with a smaller standard error of the mean (SEM), while the AOFAS showed a higher sensitivity to change.

CONCLUSIONS

Both the EFAS and the AOFAS show comparable psychometric properties. The EFAS performs better regarding SEM and internal consistency. Furthermore EFAS is a PROM without investigator bias and should therefore be preferred.

LEVEL OF EVIDENCE

III.

Digital cognitive behavioral therapy as a novel treatment for insomnia

BACKGROUND

As a substitute for traditional drug therapy, digital cognitive-behavioral therapy positively impacts the regulation of brain function, which can improve insomnia. However, there is currently a paucity of studies on digital cognitive behavioral therapy as a treatment for insomnia.

AIM

To assess digital cognitive behavioral therapy for insomnia regarding its positive impact on brain function.

METHODS

Participants were randomly assigned to either a go/no-go group or a dot-probe group. The primary outcome was quality of sleep as assessed by the actigraphy sleep monitoring bracelet, Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and depression anxiety and stress scale (DASS-21).

RESULTS

Eighty patients were included in the analysis (go/no-go group: n = 40; dot-probe group: n = 40). We combined the total scale scores of the two groups before and after the intervention in the analysis of covariance. Our study explored whether insomnia symptoms in both groups can be improved by using digital cognitive behavioral therapy instead of trying to compare the two trials; therefore, only one P value is listed. In both groups, we found a short-term time effect on insomnia symptom severity (PSQI: P < 0.001, η 2 = 0.336; ISI: P < 0.001, η 2 = 0.667; DASS-depression: P < 0.001, η 2 = 0.582; DASS-anxiety: P < 0.001, η 2 = 0.337; DASS-stress: P < 0.001, η 2 = 0.443) and some effect on sleep efficiency (but it was not significant, P = 0.585, η 2 = 0.004).

CONCLUSION

Go/no-go task training of inhibitory function had a short-term positive effect on sleep efficiency, whereas dot-probe task training had a positive short-term effect on emotion regulation.

Using Exercise Intensity to Predict a Minimal Clinically Important Difference in the Six-Minute Walk Test in People with Chronic Stroke

Background

People with chronic stroke have significant impairments in their walking capacity. Minimal clinically important differences (MCIDs) can be used to interpret changes in patient outcomes following interventions. There is significant variability in the response to moderate-to-high walking interventions in people with chronic stroke. One reason for this response variability could be the lack of understanding of the threshold exercise dose needed to achieve an MCID. The purpose of this analysis was to determine the threshold of exercise training speed most predictive of a small (≥ 20m) or moderate (≥ 50m) clinically important difference in 6MWT in people with chronic stroke.

Materials and Methods

Participants with chronic stroke with a walking speed of 0.3-1.0m/s were randomized into a 12-week (1) fast-walking training or (2) fast-walking training and step-activity monitoring intervention. This analysis included participants (n = 129; age: 63.1 ± 12.5, 46% female) with complete pre- and post-intervention data. Exercise intensity was quantified as average training speed.

Results

Receiver operating characteristic curves analyzed whether training speed is predictive of attaining a clinically important difference in the 6MWT. Training speed had poor, non-significant accuracy of predicting a small (AUC [95% CI] = 0.584 [0.475 - 0.693], p = 0.131) or moderate (AUC [95% CI] = 0.597 [0.498 - 0.696], p = 0.056) change in 6MWT.

Discussion

The average walking training speed during this high-intensity walking intervention did not accurately predict which people with chronic stroke would attain a small or moderate clinically meaningful change in 6MWT distance.

Comparing the Accuracy of Markerless Motion Analysis and Optoelectronic System for Measuring Gait Kinematics of Lower Limb

(1) Background: Marker-based optical motion tracking is the gold standard in gait analysis; however, markerless solutions are rapidly emerging today. Algorithms like Openpose can track human movement from a video. Few studies have assessed the validity of this method. This study aimed to assess the reliability of Openpose in measuring the kinematics and spatiotemporal gait parameters. (2) Methods: This analysis used simultaneously recorded video and optoelectronic motion capture data. We assessed 20 subjects with different gait impairments (healthy, right hemiplegia, left hemiplegia, paraparesis). The two methods were compared using computing absolute errors (AEs), intraclass correlation coefficients (ICCs), and cross-correlation coefficients (CCs) for normalized gait cycle joint angles. (3) Results: The spatiotemporal parameters showed an ICC between good to excellent, and the absolute error was very small: cadence AE = 1.63 step/min, Mean Velocity AE = 0.16 m/s. The Range of Motion (ROM) showed a good to excellent agreement in the sagittal plane. Furthermore, the normalized gait cycle CCC values indicated moderate to strong coupling in the sagittal plane. (4) Conclusions: We found Openpose to be accurate for sagittal plane gait kinematics and for spatiotemporal gait parameters in the healthy and pathological subjects assessed.

A systematic review of minimum important changes for generic multi-attribute utility instruments and recommendations for their estimation

INTRODUCTION

Minimum important changes (MICs) represent thresholds for clinically meaningful change. Multi-attribute utility instruments (MAUIs) generate health state utilities (holistic measures of health-related quality of life). No systematic review of MICs specifically for MAUIs has been conducted. In addition, no guidelines for estimating MICs for MAUIs have been proposed. We aimed to correct these evidence gaps by producing guidelines contextualised by a systematic review.

METHODS

We searched ten databases for relevant records using various search terms. Extracted data were analysed narratively and descriptively. The presence of key reporting items (relating to precision, sensitivity, and concurrent validity) was also evaluated. Guidelines for MIC estimation were informed by the broader MIC literature and contextualised using study results.

RESULTS

The review identified 5035 non-duplicate records, with 68 entering the study. 282 unique, anchor-based MICs were extracted. Of these MICs, 119 (42.20%) pertained to the EQ-5D-3L, 82 (29.08%) to the EQ-5D-5L, and 50 (17.73%) to the SF-6D.v1. The most common anchor-based method used to estimate MICs (107, 37.94%) involved taking the mean change score for a group considered to have experienced a MIC. Distribution-based methods were also common, appearing in 31 (45.59%) of the included studies. The inclusion of key reporting items was generally deficient.

CONCLUSIONS

Deficiencies in reporting and diverse estimation methods raise concerns regarding the extant MAUI MIC literature. Researchers should exercise caution when using existing MAUI MICs. Recommendations presented in our study may assist researchers in effectively estimating MICs for use in health economics.

Rates of achieving meaningful outcomes after undergoing minimally-invasive far lateral tubular decompression

PURPOSE

To evaluate rates of achieving meaningful outcomes among patients undergoing far lateral tubular decompression (FLTD) for neuroforaminal stenosis. Traditional midline approaches are ineffective in treating isolated neuroforaminal stenosis. Direct decompression via a far lateral approach offers a minimally invasive, facet-sparing surgery with minimal surgical dissection.

METHODS

Patients who underwent FLTD between January 2014 and January 2019 for isolated foraminal stenosis were included. The study collected patient demographics, perioperative data, and pre- and postoperative patient-reported outcomes (PROs). The study calculated thresholds for achieving minimal clinically important difference (MCID) on each PRO and performed logistic regression analysis to identify predictors of achieving meaningful clinical outcomes and clinical failure.

RESULTS

64 patients were included with a 2-year follow-up. The analysis showed improvement in each PRO over the 2-year period (p < 0.001 for all). 90.2% of patients achieved MCID for at least one PRO, with the VAS leg pain having the highest achievement rate at 79.7%. During the follow-up period, 17.2% required additional surgery. Increased severity of preoperative symptoms was associated with a greater likelihood of achieving MCID in all three PROs (p < 0.05, each). The presence of spondylolisthesis was associated with decreased odds of achieving MCID by ODI (p = 0.04). Increased operative time was associated with increased odds of achieving MCID by ODI (p = 0.03). No variables were associated with revision surgery.

CONCLUSIONS

FLTD is an effective treatment option for direct decompression of foraminal and extra foraminal stenosis in well-indicated patients. Most patients achieved MCID two years from surgery, with more severe symptoms having a greater likelihood of improvement, particularly with radicular pain. Further research should be performed on patients with spondylolisthesis to prescribe treatment resulting in maximal benefit.

LEVEL OF EVIDENCE: 4

Minimal Clinically Important Difference in Patients with Knee Cartilage Lesions Treated with a Cell-Free Scaffold Implantation

ObjectiveThe aim of this study was to establish the minimal clinically important difference (MCID) thresholds for the International Knee Documentation Committee (IKDC) subjective and Visual Analogue Scale (VAS) pain scores in patients affected by knee chondral and osteochondral lesions treated with cell-free scaffold implantation.DesignFor the MCID definition, 186 patients who underwent an osteochondral scaffold implantation were included. Patients were evaluated through the IKDC subjective and VAS pain scores at baseline, 12 and 24 months. The MCID was calculated using a distribution-based method for both IKDC subjective and VAS pain scores at 12 and 24 months, as well as with an anchor-based method.ResultsThe MCID values were 10.1 and 1.5 for the IKDC subjective and VAS pain scores, respectively, both at 12 and 24 months of follow-up. The rate of patients who achieved the MCID was 83% at 12 months and 88% at 24 months. The anchor-based method led to higher MCID values. Factors identified to increase the probability to reach the MCID were younger age (P = 0.042), male sex (P = 0.042), and lateral femoral condyle lesions (P = 0.002), while patellar lesions were less likely to reach the MCID (P = 0.009).ConclusionsThis study defined the MCID values for the IKDC subjective and VAS pain scores after treatment with a cell-free biomimetic scaffold, with 88% of the patients achieving clinically relevant results at 2 years. Younger patients, males and lateral femoral condyle lesions were more likely to reach the MCID. However, the identified thresholds can be influenced by the method chosen, which warrants caution when interpreting study results.

Variability and Reliability of the Axivity AX6 Accelerometer in Technical and Human Motion Conditions

This study aimed to evaluate the intra- and inter-instrument variability and reliability of the Axivity AX6 accelerometer under controlled technical conditions and human motion scenarios. In the first experiment, 12 accelerometers were affixed to a vibration platform and tested at four frequencies (2.2, 3.2, 6.5, and 9.4 Hz) along three axes to assess frequency- and axis-dependent variability. In the second experiment, four AX6 accelerometers were simultaneously placed on a subject's wrist and tested under four human motion conditions (walking at 4 km·h-1 and 6 km·h-1 and running at 8 km·h-1 and 10 km·h-1). Results demonstrated low intra- and inter-instrument variability (CVintra: 3.3-4.5%; CVinter: 6.3-7.7%) with high reliability (ICC = 0.98). Similar results were observed in human motion conditions (CVintra: 5.3-8.8%; CVinter: 7.1-10.4%), with ICC values of 0.98 for combined devices, and 0.99 for each device individually. Despite statistically significant differences (p < 0.05) between devices in human motion all conditions, the variations remained below the minimal clinically significant difference threshold. These findings indicate that under technical conditions on a vibrating platform, and within the range of typical human accelerations, the Axivity AX6 is a reliable tool for measuring accelerations representative of physical activity. However, further research is necessary to validate its performance under free-living conditions.

Post-mastectomy wound care - need for an empathetic approach

Mastectomy, a surgical procedure involving the removal of breast tissue, is a common treatment option for breast cancer. Post treatment, survivors often experience both physical and psychological symptoms, which in turn delay the recovery phase. Post-mastectomy wound complications, such as infection, pain, delayed healing, seroma formation, persistent discomfort and limited mobility often lead to prolonged hospital stays and reduced quality of life. Proper wound care, including dressing changes and wound management, is crucial for optimal healing. However, mastectomy also has a significant emotional and psychological impact on patients, leading to depression, anxiety, and poor body image due to significant changes in the body such as loss of hair, unsightly scars and weight changes. Patients also feel uncomfortable when medical professionals concentrate solely on survival, rather than empathizing with them. While these emotional reactions are often expected and considered normal during breast cancer treatment, what comes as a surprise is the additional harm caused by healthcare providers' communication and behaviour when treating breast cancer patients. Despite advances in medical technology, there remains a significant gap in providing psychosocial support for breast cancer survivors. Undergoing a mastectomy is an emotionally challenging experience, and healthcare providers play a vital role in establishing the groundwork for psychological recuperation. By incorporating empathetic practices into daily patient care, healthcare providers can be trained to create an unbiased, informative, and compassionate environment, to improve patient outcomes and satisfaction. The use of compassionate communication when interacting with the patient and their care givers can foster a more nurturing atmosphere for all parties involved. By prioritizing empathy in post-mastectomy wound care, healthcare providers can enhance the overall well-being of breast cancer survivors. This review explores the physical and emotional impact of mastectomy on patients, the healing process, and the importance of integrating empathy into post-mastectomy wound care.

Minimum Important Change for the Patient Evaluation Measure in patients with finger fractures and joint injuries

The Minimum Important Change of the Patient Evaluation Measure for patients recovering from a finger fracture or joint injury was estimated to aid the design of future trials. Data from the Patient Outcomes for Finger Fractures and Joint Injuries prospective cohort study were used. Sixty participants were included. Patients were given the Patient Evaluation Measure questionnaire at baseline and at 6, 12 and 24 weeks with corresponding anchor questions. The Minimum Important Change values for the Patient Evaluation Measure at 24 weeks was between 12 and 17 depending on the statistical estimation method used. Although some variation existed across differing time-points, the range was broadly consistent. The Minimal Detectable Change was estimated as between 9 and 11.Level of evidence: II.

Assessment of Neurophysiological Parameters During Anterior Cervical Discectomy and Fusion and Their Correlation with Clinical Findings

Background: In this study, we used intraoperative neurophysiological monitoring (IONM) during anterior cervical discectomy and fusion (ACDF). Rather than emphasizing its use for safety purposes, our goal was to evaluate how neurophysiological parameters change during surgery and their correlation with clinical findings. Methods: This study included 30 patients who underwent ACDF. Detailed neurological examination was performed together with manual muscle testing (MMT), the Numeric Pain Rating Scale (NPRS), and the Neck Disability Index (NDI) questionnaire. During surgery, somatosensory-evoked potentials (SSEPs), motor-evoked potentials (MEPs), and spontaneous electromyography were registered. Results: There were statistically significant difference in the latency and amplitude of SSEPs of the right median nerve. Regarding the left median nerve, there was a statistically significant difference in amplitude, but not in latency. Differences were also observed in the amplitudes of right and left tibial nerve SSEPs, though no significant differences were found in their latencies. No statistically significant difference was found in the threshold values required to elicit MEPs between the beginning and end of the surgery. Additionally, we found a statistically significant positive correlation between the latency of the left and right median nerve and the left tibial nerve with somatosensory impairment. There was also a significant negative correlation between the amplitude of both tibial nerves and somatosensory impairment, and their latency showed a significant negative correlation with pain level before surgery. We found statistically significant decreases in NDI and pain level values one month after surgery. Conclusions: The results show significant changes in SSEPs and a correlation between clinical and neurophysiological findings and emphasize the importance of using MEPs to assess the condition of the motor system. Additionally, there was a general improvement in the patients' condition, as assessed by NDI and pain scores. This study identifies critical surgical phases to consider in the absence of real-time neuromonitoring feedback and emphasizes that clinical observations may not fully reflect the condition of neurological structures in patients with myelopathy, which is crucial when deciding on timely surgery.

Challenges in Meeting Centers for Medicare and Medicaid Services Patient-Reported Outcome Measures Collection Requirements and Patient Predictors of Substantial Clinical Benefit Achievement in Total Joint Arthroplasty

BACKGROUND

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly effective procedures, with the Centers for Medicare & Medicaid Services (CMS) mandating patient-reported outcome measures (PROMs) for Medicare patients starting July 1, 2024. This study evaluated PROM collection rates and identified predictors of substantial clinical benefit (SCB), defined by CMS as a 22-point improvement in Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement for THA and a 20-point improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement for TKA at four surgical sites across an academic tertiary referral center.

METHODS

This retrospective cohort study analyzed PROM data for all patients who underwent THA or TKA from January 2021 to December 2022. Collection rates for PROMs were assessed by meeting the CMS requirement of "matched pairs" of preoperative and 1-year postoperative PROM and meeting SCB. Logistic regression was used to identify predictors of SCB.

RESULTS

Collection rates of PROMs improved from 2021 to 2022, but matched pair rates remained below 33%. The SCB was achieved by 70.9% of THA patients and 62.1% of TKA patients. Significant predictors of SCB included younger age, lower preoperative PROM scores, and absence of comorbidities such as diabetes or preoperative opioid use. Non-White race patients had significantly lower odds of achieving SCB for TKA (P = 0.003), while preoperative education did not significantly impact SCB rates for either procedure.

CONCLUSIONS

The collection of PROMs remains a major challenge, particularly for postoperative intervals, but patients who had greater initial limitations showed substantial improvement. Targeted interventions to optimize preoperative risk factors and enhance long-term follow-up may improve SCB rates and CMS compliance.

Fully personalized modelling of Duchenne Muscular Dystrophy ambulation

Duchenne Muscular Dystrophy is a progressive neuromuscular disorder characterized by the gradual weakening and deterioration of muscles, leading to loss of ambulation in affected individuals. This decline in mobility can be effectively assessed using the North Star Ambulatory Assessment (NSAA) scores, along with measures such as the 10-m walk time and the time taken to rise from the floor. We propose a dynamic linear model to predict the trajectories of these clinical outcomes, with a primary focus on NSAA scores. Our model aims to assist clinicians in forecasting the progression of the disease, thereby enabling more informed and personalized treatment plans for their patients. We also evaluate the effectiveness of our models in generating synthetic NSAA score datasets. We assess the performance of our modelling approach and compare the results with those of a previous study. We show that the most robust model demonstrates narrower prediction intervals and improved quantile coverage, indicating superior predictive accuracy and reliability.This article is part of the theme issue 'Uncertainty quantification for healthcare and biological systems (Part 2)'.

The impact of group music therapy on anxiety, stress, and wellbeing levels, and chemotherapy-induced side effects for oncology patients and their caregivers during chemotherapy: a retrospective cohort study

INTRODUCTION

Cancer is currently the second most common cause of death worldwide and is often treated with chemotherapy. Music therapy is a widely used adjunct therapy offered in oncology settings to attenuate negative impacts of treatment on patient's physical and mental health; however, music therapy research during chemotherapy is relatively scarce. The aim of this study is to evaluate the impact of group music therapy sessions with patients and caregivers on their perceived anxiety, stress, and wellbeing levels and the perception of chemotherapy-induced side effects for patients.

MATERIALS AND METHODS

This is a retrospective cohort study following the STROBE guidelines. From April to October 2022, 41 group music therapy sessions including 141 patients and 51 caregivers were conducted. Participants filled out pre- and post-intervention Visual Analogue Scales (VAS) assessing their anxiety, stress, and wellbeing levels, and for patients the intensity of chemotherapy-induced side effects.

RESULTS

The results show a statistically significant decrease of anxiety and stress levels (p < .001), an increase in well-being of patients and caregivers (p < .001, p = .009), and a decrease in patients' perceived intensity of chemotherapy-induced side effects (p = .003). Calculated effect sizes were moderate for anxiety, stress, and well-being levels, and small for chemotherapy-induced side effects.

DISCUSSION

This is the first study regarding group music therapy sessions for cancer patients and their caregivers during chemotherapy in Colombia. Music therapy has been found to be a valuable strategy to reduce psychological distress in this population and to provide opportunities for fostering self-care and social interaction.

CONCLUSIONS

Music therapy should be considered as a valuable complementary therapy during chemotherapy. However, it is crucial to conduct prospective studies with parallel group designs to confirm these preliminary findings.

Psychometric Properties of the Wolf Motor Function Test (WMFT) and Its Modified Versions: A Systematic Review With Meta-Analysis

BackgroundThe Wolf Motor Function Test (WMFT) and its modified versions are widely used to assess upper limb (UL) function in stroke survivors. However, comprehensive evaluations of its psychometric properties are lacking.ObjectiveTo perform a systematic review with meta-analysis on the psychometric properties (following the COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN] taxonomy) of the WMFT and modified versions in stroke survivors.MethodsSix databases were searched until May 2024 for studies examining at least one WMFT measurement property in stroke patients. Two independent reviewers conducted study selection, data extraction, and quality assessment using the COSMIN Risk of Bias checklist and quality of evidence (QoE) with the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analyses synthesized psychometric properties reported in at least two studies.ResultsTwenty-five studies (N = 2044) were included. Regarding the WMFT Functional Ability Scale (FAS) and TIME scales, internal consistency (alpha ≥ .88), intra-rater (intraclass correlation coefficient [ICC] ≥ .97) and inter-rater (ICC ≥ .92) reliability, measurement error for TIME, construct validity (strong correlations [r ≥| .64|] with Fugl-Meyer Assessment and Action Research Arm Test), and responsiveness (ES ≥ 0.48) were rated sufficiently with QoE from very low to high. Measurement error for FAS was assessed as inconsistent with moderate QoE, and cross-cultural validity was rated as indeterminate with very low QoE. Content validity was not assessed. Few studies investigated the psychometric properties of the modified versions.ConclusionsWMFT demonstrates robust psychometric properties in assessing UL function in stroke survivors. While the WMFT-modified versions showed promising properties, further research is needed to use them. Future studies should focus on WMFT measurement error, content, and cross-cultural validity.Trial Review Registration:PROSPERO: CRD42021237425.

Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial

Importance

Late radiation-associated dysphagia (RAD) after head and neck cancer (HNC) treatment is challenging and commonly treatment refractory, with fibrosis stiffening connective tissues and compressing peripheral nerve tracts, contributing to diminished strength and possibly denervation of swallowing muscles. Manual therapy (MT), while common for cancer-related pain and other indications, remains largely unstudied for fibrosis-related late RAD.

Objective

To determine the feasibility and safety of MT, estimate effect size and durability of MT for associated improvements in cervical range of motion (CROM), and examine functional outcomes after MT in survivors of HNC with fibrosis-related late RAD.

Design, Setting, and Participants

This nonrandomized clinical trial, Manual Therapy for Fibrosis-Related Late Effect (MANTLE) Dysphagia in Head and Neck Cancer Survivors, is a prospective, single-institution, pilot, single-arm supportive care trial conducted at a National Comprehensive Cancer Network-designated academic comprehensive cancer center. Participants were adult survivors of HNC who were disease free at 2 or more years after curative-intent radiotherapy with grade 2 or higher fibrosis (per Common Terminology Criteria for Adverse Events version 4.0) and grade 2 or higher dysphagia (per video fluoroscopy Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]). Data were collected June 2018 to July 2021 and analyzed November 2022 to November 2024.

Intervention

MANTLE included 10 hourly MT sessions by lymphedema-certified speech-language pathologists over 6 weeks with a home exercise program. During the subsequent 6-week washout period, participants implemented only the home exercise program, without clinician MT.

Outcomes and Measures

Primary end points were feasibility (per therapy completion rate, with a 75% target) and safety. Secondary end points included functional outcomes per CROM, dysphagia severity (per DIGEST), maximum interincisal opening (MIO), and validated participant-reported outcomes (PROs).

Results

Among 24 survivors of HNC (20 male [83.3%]; median [range] age, 68 [53-80] years), there was a median (range) of 8.9 (2.4-30.2) years after curative-intent radiotherapy. A total of 22 participants (91.7%) completed the 10 prescribed therapy sessions, and 1 participant experienced a severe adverse event. Secondary end points improved among participants who completed the therapy: MIO (r = 0.76; 95% CI, 0.66 to 0.94) and all 6 planes of CROM (eg, cervical extension: r = 0.86; 95% CI, 0.83 to 0.93) improved, with large effect sizes from baseline to after MT. Large to moderate effect sizes were achieved in symptom measures per PROs (eg, lymphedema-fibrosis symptom severity after MT: r = 0.74; 95% CI, 0.63 to 0.99). However, effect sizes were small to moderate or null in uncompensated swallowing outcome measures (eg, MD Anderson Dysphagia Inventory composite score from baseline to after MT: r = 0.38; 95% CI, 0.07 to 0.73).

Conclusions

This study found that MT was safe and feasible in long-term survivors of HNC with late RAD and was associated with several functional, physical, and psychosocial gains. This trial may offer insight into next directions to optimize swallowing outcomes by integrating MT into a comprehensive rehabilitation program.

Trial Registration

ClinicalTrials.gov Identifier: NCT03612531.

Minimal and robust clinically important differences for patient-reported outcome measures of fatigue in chronic stroke survivors after fatigue rehabilitation

PURPOSE

The minimal and robust clinically important difference (MCID and/or RCID) are essential in assessing the clinical significance of multidimensional fatigue inventory-20 and checklist of individual strength-fatigue subscale questionnaires changes scores. This is the first study to determine the MCID and RCID of these questionnaires in chronic stroke survivors.

MATERIALS AND METHODS

A total of 125 participants in an observational cohort study completed MFI-20 and CIS-fs before and after receiving multidisciplinary rehabilitation (cognitive behavioral therapy, graded exercise and adaptive pacing therapy). Anchor-based MCIDs and RCIDs were calculated using the mean change, the mean difference and the receiver operating characteristics methods. To evaluate the accordance between of distribution-based MCIDs (1 SD, ½ SD, SEM, 1.96 SEM and MDC values) with anchored values, the accuracy, sensitivity, specificity and Youden's index were calculated.

RESULTS

The anchored MCIDs were between -5 to -7.33 for MFI-20 and -4.87 to -5.40 for CIS-fs. The anchored RCIDs ranged from -5 to -13.88 and -6 to -9.88 for MFI-20 and CIS-fs, respectively. The values of ½ SD and SEM for CIS-fs were consistent with anchored RCIDs.

CONCLUSIONS

The estimated MCIDs and RCIDs of MFI-20 and CIS-fs can help researchers and clinicians interpret their chronic stroke patient data.

Measurement properties of the 5-repetition sit-to-stand test in patients with lumbar degenerative disorders: COSMIN systematic review

BACKGROUND CONTEXT

There has been no recent updated comprehensive review of measurement properties focused on the 5-repetition sit-to-stand test (5R-STS) in patients with lumbar degenerative disorders (LDD) that could aid in better understanding of its clinical and research applicability.

PURPOSE

The aim of this systematic review was to summarize evidence on measurement properties of the 5R-STS in patients with LDD according to COnsensus Based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines.

DESIGN

Systematic review and meta-analysis.

PATIENT SAMPLE

In Step 1 and 2, 3,363 and 1,287 adult patients with suspected or diagnosed either clinically and/or radiologically LDD were included, respectively. Step 2 involved screening studies from Step 1 that passed the full text-stage and including only those that assessed at least 1 COSMIN measurement property.

OUTCOME MEASURES

Functional Measures (5R-STS, Timed Up and Go Test). Self-report Measures (including Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire, pain scores eg, Visual Analogue Scale) and healthcare quality of life questionnaires (eg, EQ-5D-3L)).

METHODS

In December 2022 Embase, PubMed/Medline, Web of Science and Scopus were searched for studies of 5R-STS of patients with LDD (PROSPERO: CRD42022383095). Quality of evidence was assessed using GRADE and COSMIN Checklist. Results for measurement error were pooled using the weighted mean method. Random effect meta-analysis was performed for studies on reliability and criterion validity.

RESULTS

Thirty-eight full-text articles were included in Step 1 and 19 in Step 2. The overall intraclass correlation coefficient (ICC) of test-retest reliability and inter-rater reliability of the 5R-STS was 0.93 (95% CI 0.37-1.00) and 0.99 (95% CI 0.83-1.00), respectively. The weighted standard error of measurement (SEM) mean value was 2.8s. Estimated r of 5R-STS and ODI, reflecting insufficient criterion validity (since r <0.70), was 0.53 (95% CI 0.17-0.88). Hypothesis testing for construct validity was confirmed for 40% of predefined hypothesis (graded as insufficient since overall, not >70% hypothesis confirmed). Accounting for limited evidence, responsiveness of the test was adequate.

CONCLUSION

This COSMIN systematic review summarizes 5R-STS measurement properties in patients with LDD, including pooled estimates of ICC for reliability, SEM, and correlation between 5R-STS and ODI. The 5R-STS is a reliable and responsive instrument reflecting a new dimension of functional impairment in patients with LDD.

Motor Rehabilitation Provides Modest Functional Benefits After Intracerebral Hemorrhage: a Systematic Review and Meta-Analysis of Translational Rehabilitation Studies

Few certainties exist regarding the optimal type, timing, or dosage of rehabilitation after stroke. Despite differing injury mechanisms and recovery patterns following ischemic and hemorrhagic stroke, most translational stroke research is conducted after ischemia. As we enter the era of personalized medicine, exploring subtype-specific treatment efficacy is essential to optimizing recovery. Our objective was to characterize common rehabilitation interventions used after in vivo preclinical intracerebral hemorrhage (ICH) and assess the impact of post-ICH rehabilitation (vs. no-rehabilitation) on recovery of motor function. Following PRISMA guidelines, a systematic review (Academic Search Complete, CINAHL, EMBASE, Medline, PubMed Central) identified eligible articles published up to December 2022. Risk of bias (SYRCLE) and study quality (CAMARADES) were evaluated, and random-effects meta-analysis was used to assess treatment efficacy in recovery of forelimb and locomotor functions. Thirty articles met inclusion criteria, and 48 rehabilitation intervention groups were identified. Most used collagenase to model striatal ICH in young, male rodents. Aerobic exercise, enriched rehabilitation, and constraint-induced movement therapy represented ~ 70% of interventions. Study quality was low (median 4/10, range 2-8), and risk of bias was unclear. Rehabilitation provided modest benefits in skilled reaching, spontaneous impaired forelimb use, and locomotor function; however, effects varied substantially by endpoint, treatment type, and study quality. Rehabilitation statistically improves motor function after preclinical ICH, but whether these effects are functionally meaningful is unclear. Incomplete reporting and variable research quality hinder our capacity to analyze and interpret how treatment factors influence rehabilitation efficacy and recovery after ICH.

A feasibility study of an add-on psychomotor body-image protocol during CBT-E in female patients with an eating disorder

BACKGROUND AND OBJECTIVES

Disturbed body image is a potential precursor and maintaining factor when it comes to eating disorders. One of the dominant treatment approaches for eating disorders, enhanced cognitive-behaviour therapy (CBT-E), includes the cognitive-affective body image dimension as a core treatment target. Adding a component that focuses on the lived body dimension, could improve body image. In the current study, the feasibility of a psychomotor body image treatment as an add-on to CBT-E was examined.

METHODS

In this pilot study, 115 primarily female patients with different eating disorders in outpatient CBT-E treatment participated. They were asked to complete questionnaires examining body image before and after the psychomotor body image treatment.

RESULTS

Results showed good satisfaction with the treatment, and a significant improvement in body attitude and body satisfaction after the psychomotor body image treatment, with large effect sizes and clinical relevance. Results also showed that, overall, pre-treatment levels and changes over the course of treatment in body attitude and body satisfaction did not differ between patients within anorexia nervosa, bulimia nervosa or binge eating disorder diagnostic subgroups.

LIMITATIONS

Limitations were lack of a control group, and the fact that the body image treatment was complementary to CBT-E. This means that it is unclear whether other factors contributed to the change in body image as shown in the current study.

CONCLUSIONS

These results indicate that an experiential psychomotor approach in addition to a more cognitive-behavioral approach is feasible, and warrants future research.

Evaluating shoulder pain and disability index (SPADI) outcomes post-rotator cuff repair: Minimal clinically important difference (MCID), patient acceptable symptom state (PASS) and substantial clinical benefit (SCB) analysis

BackgroundThe Shoulder Pain and Disability Index (SPADI) is one of the most widely used Patient Reported Outcome Measures designed to assess the severity of pain and disability in patients with shoulder conditions.ObjectiveThe aim of the study is to define the clinically significant outcomes of the Minimum Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) for the SPADI scores after Rotator Cuff Repair (RCR).MethodsThe present study takes into account patients undergone RCR with a 6-month follow-up. The MCID, PASS and SCB of the SPADI score were evaluated using both distribution and anchor approaches.ResultsFifty-nine patients (mean aged 60.3 ± 13.1 years) who had undergone RCR in a single surgical center were retrospectively included. The MCID cutoff of the SPADI total score after RCR from the initial evaluation to 6 months post-operatively was 17 (95% CI:13.6,20.4). The outcome measures for the MCID and SCB values of the SPADI pain score were 26 (95% CI:22.3,29.7) and 37 (95% CI:33.4,40.6), respectively. The MCID threshold of the SPADI disability score was 21.9 (95% CI:18.7,25.1). A value of at least 76.9 (95% CI:73.4,80.4), 75 (95% CI:71.6,78.4), and 78.1 (95% CI:74.6,81.6) for SPADI total, pain, and disability dimensions, represented the PASS.ConclusionsThe study shows significant improvements in SPADI scores after RCR, suggesting that could lead to meaningful pain relief and functional recovery. The findings indicate that a post-operative SPADI total score of at least 76.9 correlates with patient satisfaction regarding shoulder health.

Assessment of minimum clinically important difference in symptoms and functionality of Japanese patients with major depressive disorder following inadequate response to antidepressants: a post hoc analysis of the long-term study of brexpiprazole augmentation therapy in Japanese patients with major depressive disorder

Background and objectives

The aim of this study was to apply the minimum clinically important difference (MCID) concept to clinical results for Japanese patients with major depressive disorder following inadequate response to antidepressants, and to explore the disparity in what physicians and patients considered important in the treatment of depression.

Methods

The original study was a 52-week, open-label, multicenter study on the administration of 2 mg/d of brexpiprazole as adjunctive therapy for patients with major depressive disorder. Here, we conducted a post hoc analysis to determine the MCID in Montgomery-Åsberg Depression Rating Scale (MADRS), Sheehan Disability Scale (SDS), and EQ-5D-5L-derived utility score. We compared the area under the curve (AUC) and correlation coefficients for the MADRS, SDS, and utility scores between the physicians' and patients' responses.

Results

The MCIDs for this patient group were 4.89-4.94 for the MADRS score, 31.15-35.10% for the MADRS improvement rate, 0.69-2.14 for the SDS score, and 0.045-0.195 for the utility score. The MCIDs for the SDS and utility scores derived from the patient-perspective anchor were almost twice as high as those from the physician-perspective anchor. The utility score had the highest AUC and correlation coefficient for the patient-perspective anchor, while the MADRS score did for the physician-perspective anchor.

Conclusions

The MCIDs for the MADRS, SDS, and EQ-5D-5L -derived utility scores were estimated. Physicians focus more on depressive symptoms and prioritize symptom severity over improvements in functionality and activities of daily life, in contrast to patients, who prioritize such improvements.

Beyond statistical significance: Embracing minimal clinically important difference for better patient care

The minimal clinically important difference (MCID) represents a pivotal metric in bridging the gap between statistical significance and clinical relevance, addressing the direct impact of medical interventions from the patient's perspective. This comprehensive review analyzes the evolution, applications, and challenges of MCID across medical specialties, emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs. We discuss the evolution of MCID since its inception in the 1980s, its current applications across various medical specialties, and the methodologies used in its calculation, highlighting both anchor-based and distribution-based approaches. Furthermore, the paper delves into the challenges associated with the application of MCID, such as methodological variability and the interpretation difficulties that arise in clinical settings. Recommendations for the future include standardizing MCID calculation methods, enhancing patient involvement in setting MCID thresholds, and extending research to incorporate diverse global perspectives. These steps are critical to refining the role of MCID in patient-centered healthcare, addressing existing gaps in methodology and interpretation, and ensuring that medical interventions lead to significant, patient-perceived improvements.

An assessment of the teacher completed 'Early Years Foundation Stage Profile' as a routine measure of child developmental health

The routine measurement of children's developmental health varies across educational settings and systems. The Early Years Foundation Stage Profile (EYFSP) is a routinely recorded measure of a child's development completed at the end of their first school year, for all children attending school in England and Wales. Despite widespread use for research and educational purposes, the measurement properties are unknown. This study examined the internal consistency and structural validity of the EYFSP, investigating whether the summed item-level scores, which we refer to as the 'total score', can be used as a summary of children's developmental health. It also examined predictive validity of the total score with respect to later academic attainment and behavioural, social, and emotional difficulties. The data source was the longitudinal prospective birth cohort, Born in Bradford (BiB), and routine education data were obtained from Local Authorities. The internal consistency and structural validity of the EYFSP total score were investigated using Confirmatory Factor Analysis and a Rasch model. Predictive validity was assessed using linear mixed effects models for Key Stage 2 (Maths, Reading, Grammar/Punctuation/Spelling), and behavioural, social, and emotional difficulties (Strengths and Difficulties Questionnaire). We found that the EYFSP items demonstrated internal consistency, however, an Item Response model suggested weak structural validity (n = 10,589). Mixed effects regression found the EYFSP total score to predict later academic outcomes (n = 2711), and behavioural, social, and emotional difficulties (n = 984). This study has revealed that whilst caution should be applied for measurement of children with close to 'average' ability levels using the EYFSP, the EYFSP total score is an internally consistent measure with predictive validity.

Estimating the minimum clinically important difference (MCID) of the five-repetition sit-to-stand test in patients with lumbar disc herniation

BACKGROUND

The impact of surgical interventions on lumbar disc herniation (LDH) is often assessed using objective functional impairment (OFI) tests like the five-repetition sit-to-stand (5R-STS) test. This study calculates the minimum clinically important difference (MCID) for 5R-STS improvement in patients with LDH one year after surgery.

METHODS

Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Numeric Rating Scale for back and leg pain, EQ-5D-3L health-related quality of life questionnaire and EQ5D-VAS were recorded preoperatively, at 6-weeks and 1-year post-operatively. The MCID was calculated using anchor-based methods (within-patient change; between-patient change; and receiver-operating characteristic approaches) and distribution-based methods (0.5 standard deviation (SD); effect size; standard error of measurement; standardized response mean; and 95% minimum detectable change (MDC)). The final MCID value was based on the "gold standard": an averaging of the anchor-based methods using ODI and RMDQ as the closest available anchors.

RESULTS

We prospectively recruited 134 patients. One-year follow-up was completed by 103 (76.8%) of patients. The MCID values derived using different methods varied from 0.7 to 5.1 s (s). The final, averaged, anchor-based MCID for improvement was 3.6 s. Within distribution-based methods, 95% MDC and 0.5SD approach, yielded an MCID of 3.0 and 3.8 s, respectively, aligning closely with the overall anchor-derived MCID for 5R-STS.

CONCLUSION

In a patient with LDH, an improvement in 5R-STS performance of at least 3.6 s can be regarded as a clinically relevant improvement.

Therapeutic Effectiveness of Lumbar Medial Branch Block and Lumbar Intra-Articular Facet Injections: A Propensity-Matched Cohort Study

BACKGROUND

Chronic low back pain is a prevalent condition that is treated commonly with radiofrequency neurotomy (RFN) after diagnostic targeting with medial branch blocks (MBB) or intra-articular (IA) injection.

PURPOSE

We evaluated the long-term therapeutic value of MBB and IA injection of steroids for relief from chronic low back pain beyond the current diagnostic utility.

METHODS AND OUTCOME MEASURES

This was a retrospective propensity-matched cohort study from a single physician injection census at a tertiary care hospital. A total of 460 patients receiving MBB (n=383) or IA injection (n=77) in 2013-2020 were included. Primary outcome measures were patient-reported outcomes (PROs) at the time of injection, and follow-up at three and six months with the Numerical Rating Scale (NRS), PRO Measurement Information System (PROMIS)-Mental Health (MH), PROMIS-Physical Health (PH), and the Patient Health Questionnaire (PHQ)-9 scores. The same PROs at the one-year follow-up were the secondary outcome measures. Propensity weighting was performed to balance MBB and IA injection groups over several demographic and clinical categories.

RESULTS

Significant improvements in NRS (p=<0.001) were reported at the three-month, six-month, and one-year follow-ups, while significant improvements in PROMIS-PH scores (p=0.015) were identified at three and six months post injection.

CONCLUSIONS

Our results suggest that MBB and IA injection have potential therapeutic benefits for chronic low back pain for at least six months post injection. These results suggest that there is value in these diagnostic modalities therapeutically beyond the acute time frame. These results lay the groundwork for additional investigations into treatment options for patients affected by chronic low back pain.

How to Estimate the Minimal Clinically Important Difference: An Overview

The minimal clinically important difference (MCID) is a threshold above which a score change would represent a change in symptoms that is noticeable by patients, and it has become a standard approach in the interpretation of clinical relevance of changes in PROMs at a population level. Given the lack of a methodological gold standard, high variability is the main limitation of MCID. Reporting both anchor and distribution-based MCID estimates is a strategy that guarantees both patient-perceived clinical relevance and statistical significance.

Minimum important difference of shuttle walk tests in patients with interstitial lung disease following pulmonary rehabilitation

Background

Pulmonary rehabilitation (PR) is recommended for patients with interstitial lung disease (ILD). The impact of PR on exercise capacity, symptom management and mortality risk in ILD is well established; however, there are limited studies reporting on the minimal important difference (MID) for shuttle walk tests (SWTs) in the ILD population. The aim of this study was to establish the MID for both the incremental and endurance shuttle walking tests (ISWT/ESWT) in the ILD population and to evaluate the association with survival.

Participants

The study includes 207 participants with ILD (mean±sd age 71.1±9.5 years, forced vital capacity 2.32±0.79 L) who completed PR.

Results

The baseline ISWT was 251.4±153.3 m and ESWT was 217.7±136.3 s. There were significant improvements for both the ISWT and ESWT following the PR programme (44.5±77.0 m (p<0.001) and 312.3±338.6 s (p<0.001)). MID was calculated through a combination of distribution (0.5×sd) and anchor-based techniques (global rating of change (GROC) and receiver operating characteristic (ROC) analysis). The distribution-based technique yielded an MID of 38.5 m for ISWT and 169.3 s for ESWT. ROC analyses yielded an MID of 35 m for ISWT and 200 s for ESWT; and the GROC yielded an MID of 58.5 m for ISWT and 209.0 s for ESWT. Survival analysis showed that improvements in exercise tolerance are associated with improved survival.

Conclusion

Our data suggest an MID of 35.0-38.5 m for ISWT and 170-209 s for ESWT for patients with ILD. The size of improvements in SWT is associated with a survival advantage in ILD individuals who attend and complete PR.

Outpatient interdisciplinary multimodal pain treatment programme for patients with chronic musculoskeletal pain: a longitudinal cohort study

PURPOSE

To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment.

MATERIALS AND METHODS

Data were gathered during routine clinical practice during a 3-year period (2019-2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates.

RESULTS

Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain.

CONCLUSIONS

At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.

Inconsistencies in clinically significant outcome metrics for knee cartilage repair: a systematic review

To systematically review the variability of reporting of clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom state (PASS), and threshold calculation methods following surgical treatments for cartilage defects of the knee. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search was performed on August 12th, 2024, using the PubMed, Embase, and Scopus online databases for human clinical studies with publication dates ranging from 2010 to 2024 reporting on MCID, SCB, or PASS following surgical treatments for cartilage defects of the knee. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and methods of CSO calculation were collected. A total of 19 studies (n = 3659 patients) with an average follow-up of 36.5 months were included. A total of 14 (93.3%) studies reported MCID, six (31.8%) studies reported SCB, and five (26.3%) studies reported PASS. Of the included studies, 16 (80%) referenced another study for calculating their CSO whereas three (20%) studies calculated their own CSO. A total of 16 different PROMs were reported among the included studies. Eight studies utilized the anchor-based method for CSO calculation, ten studies used both the anchor and the distribution-based methods for calculation, while only one study used the distribution-based method alone. There is considerable variation in the reporting and calculation methods of MCID, SCB, and PASS for different PROMs following surgical treatments for cartilage defects of the knee.Level of Evidence: IV, Systematic Review of Level I-IV studies.

The Power of Prehabilitation, the Reporting of Power Calculations in Randomized Clinical Trials Evaluating Prehabilitation in Cancer Surgery: A Systematic Review and Meta-research Study

OBJECTIVE

To assess sample size calculation reporting in randomized controlled trials (RCTs) investigating prehabilitation interventions in oncological surgery patients.

DATA SOURCES

A systematic literature search was performed in multiple medical databases from inception to April 2023, including MEDLINE, Embase, The Cochrane Library, CINHAL, AMED, and PsychINFO.

STUDY SELECTION

The inclusion criteria used were RCTs evaluating effectiveness of exercise, nutrition, and/or psychological interventions on postoperative outcomes of adult patients undergoing oncological surgery.

DATA EXTRACTION

Two authors (DS and SV) extracted information on the sample size calculation parameters, including type I error (α), power (1-β), mean (or mean difference between randomization arms), and variance (eg, standard deviation) for continuous outcomes, and event rates or event rate difference between randomization arms for dichotomous outcomes. When possible, we recalculated the sample size required using the collected data, given a 10% margin of error.

DATA SYNTHESIS

Of the 59 included publications (58 RCTs), 26 (44%) reported sufficient information to complete sample size recalculation. Of those that provided sufficient information allowing us to recalculate the required sample size, 11 (42%) were within a 10% margin of the reported sample size, whereas 9 (35%) were >10% higher than reported sample size and 6 (23%) were >10% lower than reported sample size.

CONCLUSIONS

Over half of the published RCTs in this field exhibit poor sample size calculation reporting. Most RCTs that report sufficient sample size information were underpowered. More stringent reporting requirements are necessary.

What Are the Minimum Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptom State Thresholds for the Modified Harris Hip Score and International Hip Outcome Tool 12 Among Patients Who Undergo Periacetabular Osteotomy?

BACKGROUND

The utility of patient-reported outcome measures (PROMs) has been well established, but their interpretation relies on population-specific definitions of meaningful improvement. As such, the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) thresholds have become prominent metrics in the orthopaedic evidence to ascribe clinical relevance to numeric PROM scores. Studies assessing outcomes of periacetabular osteotomy (PAO) relative to the MCID and PASS have previously evaluated patients against thresholds defined for hip arthroscopy for the treatment of femoroacetabular impingement or distribution-based MCID calculations. These scores may not accurately reflect the status or expectations of patients with a different symptom profile undergoing open hip preservation surgery.

QUESTIONS/PURPOSES

For patients treated with PAO, we sought to (1) define the MCID, SCB, and PASS threshold values for the mHHS (modified Harris hip score) and International Hip Outcome Tool 12 (iHOT-12) using anchor-based methods; (2) assess the validity of MCID and SCB estimates against minimal detectable change (MDC) values; and (3) determine the proportion of patients who achieved a clinically meaningful threshold.

METHODS

Between February 2011 and May 2023, a total of 690 patients underwent PAO for symptomatic acetabular dysplasia at one institution and were included in a longitudinally maintained hip preservation registry. The cohort used to define and validate MCID, SCB, and PASS threshold values consisted of those with a completed postoperative anchor questionnaire, which yielded 456 patients as potentially eligible. An additional 139 patients were excluded because of missing mHHS or iHOT-12 scores during the eligibility window (1 to 2 years postoperatively), leaving 70% (317 of 456) of patients to define and validate MCID, SCB, and PASS at a mean ± SD of 1.0 ± 0.3 years of follow-up. A minimum 1-year follow-up was chosen to reduce recall bias. The cohort for defining MCID, SCB, and PASS (94% [298 of 317] women, mean ± SD age at time of surgery 27 ± 8 years) included 21% (68 of 317) of patients with prior ipsilateral surgery. From those registry patients without complete anchor questionnaires, 37% (137 of 373) were identified with pre- and postoperative PROM scores at a mean ± SD of 1.0 ± 0.9 years of follow-up to form the sample for assessing the proportion of patients achieving a clinically meaningful threshold. The MCID, SCB, and PASS thresholds for the mHHS and iHOT-12 were calculated through an anchor-based approach, using area under the receiver operating curve to determine cut points that best identified positive responses, according to quality of life-based anchor questions. The MDC was calculated with confidence intervals (CIs) reflecting 80%, 90%, and 95% certainty to determine the smallest change in the PROM scores that can be considered above the level of measurement error. The validity of MCID estimates was assessed by confirming that they exceeded corresponding MDC values. The validity of SCB estimates were assessed by confirming that they exceeded corresponding MCID values. The proportion of patients achieving a clinically meaningful threshold was determined by calculating the percentage of patients who met the defined anchor-based scores.

RESULTS

The MCID, SCB, and PASS thresholds for the mHHS were 18, 23, and 71, respectively. The MCID, SCB, and PASS thresholds for the iHOT-12 were 26, 42, and 65, respectively. The MDC ranged from 8 to 12 for the mHHS and 10 to 16 for the iHOT-12. The MCID values for the mHHS and iHOT-12 exceeded corresponding values of the MDC at all CIs. The SCB thresholds exceeded all corresponding MDC and MCID values. Across the mHHS and iHOT-12, the proportion of patients who achieved an MCID at the first time point ranged from 60% to 73%, the proportion of patients who achieved the SCB ranged from 49% to 56%, and the proportion of patients who achieved the PASS threshold ranged from 55% to 79%. Among the cohort for defining MCID, SCB, and PASS, the proportion of patients achieving any MCID, SCB, or PASS was 79%, 66%, and 81%, respectively. Among the sample for assessing the proportion of patients achieving a clinically meaningful threshold, the proportion achieving any MCID, SCB, or PASS threshold was 74%, 58%, and 72%, respectively.

CONCLUSION

We found that using a sample of patients undergoing PAO, the anchor-based values for the MCID and SCB were generally larger than previous distribution- and anchor-based scores that have been defined for hip preservation, whereas PASS threshold scores were similar. All MCID and SCB thresholds exceeded corresponding MDC values, confirming these scores to be valid estimates. These metrics provide more rigorous, procedure-specific definitions for the evaluation of treatment success and failure after PAO. As anchor-based metrics are defined based on patients' perceptions, they should be used preferentially for postoperative assessment over distribution-based scores.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Quantifying Tinnitus Perception Improvement: Deriving the Minimal Clinically Important Difference of the Minimum Masking Level

PURPOSE

Tools that can reliably measure changes in the perception of tinnitus following interventions are lacking. The minimum masking level, defined as the lowest level at which tinnitus is completely masked, is a candidate for quantifying changes in tinnitus perception. In this study, we aimed to determine minimal clinically important differences for minimum masking level.

METHOD

A 3-month tinnitus intervention combining counseling and sound therapy was conducted in 74 participants with chronic tinnitus. Minimum masking levels were measured at baseline and 3 months. The clinical global impression was evaluated at 3 months to measure changes in participants' self-perception of tinnitus. The minimal clinically important difference of the minimum masking level was calculated using anchored-based, effect size, standard error measurement, and receiver operating characteristic curve analysis.

RESULTS

The minimal clinically important difference analysis of the minimum masking level yielded a -5.5 dB SL from the receiver operating characteristic curve, a -8.1 dB SL from the standard error measurement, a -9.2 dB SL from the effect size, and a -10.3 dB SL from the anchor-based analysis. Of these, the minimal clinically important difference value with optimized sensitivity (.704) and specificity (.957) was a -5.5 dB SL, determined using receiver operating characteristic analysis.

CONCLUSIONS

The proposed minimal clinically important difference value of the minimum masking level (-5.5 dB SL) provides a good level of sensitivity and specificity. Therefore, the minimum masking level may be an alternative for measuring changes in tinnitus perception.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28156229.

Aerobic Exercise Prescription for Pain Reduction in Fibromyalgia: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVE

Fibromyalgia is a condition characterised by disabling levels of pain of varying intensity. Aerobic exercise may play a role in reducing pain in these patients. The aim of this review is to assess the dose of aerobic exercise needed, based on the frequency, intensity, type, time, volume and progression (FITT-VP) model, to obtain clinically relevant reductions in pain.

DATABASES AND DATA TREATMENT

A systematic review and meta-analysis of randomised clinical trials was conducted in the Web of Science (WoS), PEDro, PubMed and Scopus databases, the search having been conducted between July and October of 2023. Risk of bias was assessed with the Cochrane Risk of Bias assessment tool 2.

RESULTS

Seventeen studies were included. The risk of bias varied, with six studies showing low risk; five, some concerns; and six, high risk. Aerobic exercise interventions were analysed using the FITT-VP model. Frequency ranged from 1 to 10 times per week, intensity varied from light to vigorous, and the types of exercise included music-based exercise, interval training, pool-based exercise, stationary cycling, swimming and walking. The intervention durations ranged from 3 to 24 weeks, with session lengths ranging from 10 to 45 min. Most of the studies presented significant differences, favouring aerobic exercise (MD -0.49; CI [-0.90, -0.08; p = 0.02]), with moderate to low heterogeneity in subgroup analyses.

CONCLUSIONS

The study findings underscore the efficacy of aerobic exercise in alleviating pain among fibromyalgia patients, advocating for tailored exercise dosing to optimise adherence and outcomes.

SIGNIFICANCE STATEMENT

Individuals with fibromyalgia should engage in aerobic exercises two to three times weekly, for twenty-five to forty minutes in each session, aiming for more than a hundred minutes per week. They should start at low intensity, gradually increasing to higher intensities over six to twelve weeks, for optimal pain management. Exercise types should be selected in collaboration with the patient and based on personal preferences and accessibility, such as walking, and swimming, to ensure long-term adherence to the regimen.

Prognostic factors of nonsurgical intervention outcomes for patients with frozen shoulder: a retrospective study

PURPOSE

This study aimed to investigate the correlation between mental and physical health-related quality of life and the outcomes of conservative treatment in patients with frozen shoulder (FS).

METHODS

This was a two-center retrospective study. It included 84 consecutive patients who underwent a 3-month treatment comprising education, physical therapy, and corticosteroid-anesthetic injections. Changes in range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) scores, measured at baseline and after 3 months, were selected as dependent variables. Data on age, sex, Body Mass Index, duration of symptoms, dominant affected limb, and Short Form-36 (SF-36) subscales were gathered at baseline and investigated as prognostic factors. Backward stepwise regression models were used to identify significant associations.

RESULTS

At 3-month follow-up, all the patients showed significant improvement. Higher SF-36 General Health, Mental Health and Social Functioning scores at baseline were associated with a greater beneficial change in ROM and SPADI. In contrast, lower SF-36 Bodily Pain and Role Emotional scores were found to be associated with greater improvement.

CONCLUSION

The study findings indicate that the self-perceived mental and physical health of patients have a significant impact on both subjective and objective clinical outcomes and healthcare professionals should take these aspects into account.

LEVEL OF EVIDENCE

Prognostic Level II.

Use of Minimal Important Difference for Patient-Reported Outcome Measures in Plastic Surgery: A Systematic Review

BACKGROUND

The minimal important difference (MID) is vital to consider when interpreting the clinical importance of observed changes from surgical interventions assessed by patient-reported outcome measures (PROMs). There is no accepted standard for how to calculate MIDs, and uptake in the plastic surgery literature is unknown, leading to methodologic and interpretation issues.

METHODS

Medline and Embase were searched to identify all plastic surgery randomized controlled trials (RCTs) using PROMs as outcomes and MID estimation studies for PROMs used by RCTs. Included studies were assessed for uptake and application of MIDs, and MID estimation methodology and values were categorized.

RESULTS

A total of 554 RCTs using PROMs as outcomes were identified. Of these, 419 RCTs had the possibility of incorporating a previously published MID. The uptake rate of MIDs was 11.5% ( n = 48 of 419). The most common ways MIDs were applied were to calculate sample size (37.5%) or to determine whether results were clinically important (35.4%). A total of 99 studies estimating MID values for the most common PROMs in plastic surgery, based on our review, were analyzed. The most common estimation methodologies were receiver operating characteristic curve analysis (49%), change difference (31%), and SD (25%).

CONCLUSIONS

This review highlights limited uptake and application of MIDs in plastic surgery. The authors propose 4 major barriers: (1) no repository of published MIDs for PROMs used in plastic surgery exists; (2) available MIDs are not specific to plastic surgery populations; (3) high heterogeneity in MID estimation methodology was present; and (4) there are wide ranges in MID values, with no superior choice identified.

Minimal Clinically Important Difference in the Brief Assessment of Cognition in Schizophrenia-Japanese Version Composite Score: A Single-Center Preliminary Study

Background

Cognitive dysfunction is a major symptom in schizophrenia associated with social skills. It has been reported that cognitive rehabilitation can improve cognitive dysfunction. The Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J) is often used as an outcome measure to assess the effectiveness of cognitive rehabilitation. However, the minimal clinically important difference (MCID) in the BACS-J composite score has not been reported. Therefore, we conducted this study to calculate a preliminary MCID in the BACS-J composite score and confirm the feasibility of retrospective data collection and analysis for future large-scale studies.

Methods

The medical records of patients with schizophrenia who underwent cognitive rehabilitation were retrospectively surveyed. BACS-J data were collected at the beginning and end of the cognitive rehabilitation, and Clinical Global Impression-Improvement (CGI-I) data obtained at the end of the cognitive rehabilitation were evaluated retrospectively. To calculate the MCID in the BACS-J composite score using distribution-based methods, the standard error of measurement was calculated as a characteristic of the scale itself. To calculate the MCID using anchor-based methods, the mean change in BACS-J score corresponding to "minimally improved" on the CGI-I was determined.

Results

Twenty-eight patients were included in this study, and BACS-J data were collected from all patients. The CGI-I was completed by 11 patients, 3 of whom showed "minimally improved" according to their CGI scores. Distribution-based methods applied to the data of 28 patients revealed an MCID of 0.735 for the BACS-J composite score. Anchor-based methods were ultimately not applied because the sample size was insufficient.

Conclusion

This study confirmed that CGI and BACS-J data can be collected and analyzed retrospectively. According to distribution-based methods, an increase of approximately 0.7 in the BACS-J composite score can be considered clinically meaningful. Future studies with larger sample sizes using both calculation methods could provide more accurate MCID.

Defining benefit: Clinically and biologically meaningful outcomes in the next-generation Alzheimer's disease clinical care pathway

To understand the potential benefits of emerging Alzheimer's disease (AD) therapies within and beyond clinical trial settings, there is a need to advance current outcome measurements into meaningful information relevant to all stakeholders. The relationship between the impact on disease biology and clinically measurable outcomes in cognition, function, and behavior must be considered when defining the meaningful benefit of early AD therapies. In this review, we discuss: (1) the lack of consideration for biomarkers in the current concept of meaningfulness in AD; (2) the lack of gold standards for determining minimal biologically and clinically important differences (MBCIDs) in AD trials; (3) how the treatment benefits of disease-modifying treatments are cumulative and increase over time; and (4) the different concepts of meaningfulness among key stakeholders. This review utilizes the future clinical biological framework of AD and aims to further integrate and expand the parameters of meaningful benefits toward a precision medicine framework. HIGHLIGHTS: Definition of meaningful benefit from Alzheimer's disease (AD) treatment varies across disease stage and stakeholder perspectives. Observable and meaningful outcomes must consider the clinical-biological nature of AD. Statistically significant effects or outcomes do not always equate to clinically meaningfulness. Assessment tools must reflect stage-specific subtle changes following treatment. Real-world evidence will support consensus, definition, and interpretation of clinical meaningfulness.

Minimal Clinically Important Difference of Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI)

OBJECTIVE

To calculate the minimal clinically important difference (MCID) for the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).

STUDY DESIGN

Prospective cohort study.

SETTING

A single tertiary care balance and falls center.

METHODS

Fifty-three subjects meeting Barany Society criteria for vestibular migraine (VM) or probable VM were included and divided into 3 treatment groups. Treatment was not standardized, instead, management was decided individually between each patient and their provider. All subjects completed VM-PATHI before and after intervention. A Global Rating of Change (GRoC) questionnaire was also completed following intervention. Anchor-based methods, using a GRoC questionnaire, were utilized to estimate the MCID that produced the highest sensitivity and specificity on a receiver operating characteristic (ROC) curve.

RESULTS

Forty-three subjects were classified as responders and 10 were classified as nonresponders. The mean VM-PATHI pretreatment score minus the posttreatment score between the responders (mean = 14, SD 13) and nonresponders (mean = 4 SD = 12) was statistically significant (mean difference = 10, 95% confidence interval, CI [1, 20], P = .03). The VM-PATHI score change cutoff that best differentiated between responders and nonresponders was a VM-PATHI change of 6. Thus, the MCID was defined as a change of 6 points (sensitivity = 72%, specificity = 70%). The area under the ROC curve was 0.89, 95% CI [0.80, 0.98], which demonstrates an excellent ability for the VM-PATHI score change to discriminate between responders and nonresponders. The average change in VM-PATHI scores was 9 points (SD 11) for those with "a little better" rating on the GRoC, 14 points (SD 14) for those with a "moderately better" rating, and 20 points (SD 13) for those with a "very much better" rating.

CONCLUSION

Patients with VM are likely to demonstrate clinical improvement if their VM-PATHI score decreases by 6 or more.

Hardware Removal After Lisfranc Open Reduction and Internal Fixation Results in Improved Physical Function

OBJECTIVES

The purpose of this study was to investigate whether hardware removal (HWR) after Lisfranc open reduction and internal fixation (ORIF) resulted in significant impact through PROMIS physical function (PF) and pain intensity (PI) scores.

METHODS

DESIGN

Retrospective cohort.

SETTING

Level-1 trauma center.

PATIENT SELECTION CRITERIA

Adult patients with isolated Lisfranc injuries who were treated through ORIF between 2002 and 2023 who had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention before HWR. A subanalysis was performed at 1-year follow-up.

OUTCOME MEASURES AND COMPARISONS

Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR versus no HWR. Distributive MCID was calculated using the 0.5 SD method.

RESULTS

There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) years versus the HWR group that was 38.7 (18.3-74.1) years ( P = 0.053). Nineteen (63.3%) were women in the no HWR group compared with 33 (42.9%) in the HWR group ( P = 0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7-45.9, P < 0.001) at their standard 6 weeks (1.5 months) postoperative visit. HWR patients had a nonsignificant decrease in average PI scores (56.5-53.9, P = 0.24). Compared with those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively ( P = 0.002, 0.008).

CONCLUSIONS

Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared with patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.