Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) Applied to the SF-36 in Patients Who Underwent Arthroscopic Rotator Cuff Repair

A randomized controlled trial: Mobile app vs videoconference telerehabilitation for rotator cuff tendinopathy

IntroductionThe aim of this study was to compare the effectiveness of two methods of telerehabilitation (TR) delivery: mobile health TR (mHealth-TR) and video conference TR (VC-TR) in improving outcomes for patients with RC tendinopathy.MethodsEighty-five participants diagnosed with RC tendinopathy were randomized into synchronous (VC-TR) and asynchronous (mHealth-TR) groups. Both groups received an identical 8-week exercise programme delivered through their assigned platform. The programme included scapular mobilization, range-of-motion, strengthening, and stretching exercises. The primary outcomes were pain level (Visual Analogue Scale [VAS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH] score), quality of life (Short Form-36 Health Survey [SF-36] score), and shoulder mobility (universal goniometer). The assessments were carried out at baseline, after the treatment (week 8) and at a follow-up of 16 weeks.ResultsThe mean participant age was 51.8 years (SD 9.24), with 27% (n = 23) male. No significant between-group differences were observed for pain (VAS) or shoulder mobility (P > .05 for both). However, a significant group-by-time interaction effect was found for disability, measured by the DASH score (F(1,83) = 10.56, P = .001), and quality of life, measured by the SF-36 overall score (excluding physical role functioning, emotional role functioning, and social function) (Vitality/Energy: F(1,83) = 7.34, P = .006; Pain: F(1,83) = 4.78, P = .034; General Health: F(1,83) = 4.82, P = .032). Post-hoc analysis indicated significant improvements in disability and quality of life scores in the synchronous VC-TR group compared to the asynchronous mHealth-TR group. Specifically, DASH scores in the synchronous group decreased by 9.41 points (95% CI: 3.46 to 15.36, P = .002) from baseline to after treatment, and by 9.34 points (95% CI: 3.48 to 15.20, P = .002) by the 16th week. For quality of life, the VC-TR group showed significant improvements in the Vitality/Energy, Pain, and General Health domains from baseline to follow-up, with mean differences of 6.41, 11.68, and 10.83, respectively (all P < .05).DiscussionThis study suggests that patients with RC tendinopathy may experience greater improvements in pain management, disability, and overall quality of life through synchronous VC-TR compared to asynchronous mHealth-TR.

Effect of age and gender in rates of achieving minimal clinically important difference and patient-acceptable symptom state 2 years after arthroscopic superior capsular reconstruction

PURPOSE

This study aimed to evaluate patient-reported outcome measures (PROMs) and the effects of gender and age on achieving clinically significant outcomes in patients undergoing arthroscopic superior capsular reconstruction (ASCR) with a minimum 2-year follow-up.

METHODS

Patients undergoing ASCR for irreparable rotator cuff tear between 2013 and 2020 were reviewed. Preoperative and minimum 2-year postoperative PROMs were collected, including American Shoulder and Elbow Surgeons (ASES), Constant, single assessment numeric evaluation (SANE), and visual analog scale (VAS) scores. Minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were calculated for each functional score and analyzed according to age and gender. The percentages of patients achieving MCID and PASS were recorded.

RESULTS

The study included 83 patients, with a mean follow-up of 3.5 ± 1.4 years. Significant improvements were found in ASES, Constant, SANE, and VAS for all groups based on gender and age. Based on receiver-operating characteristic curves, all scores had acceptable areas under the curve for PASS. Values for PASS and MCID were 81.5 and 10.3 for ASES; 61.5 and 6.2 for Constant; 82.5 and 11.5 for SANE and 1.5 and 1.1 for VAS, respectively. Analysis of achieving MCID and PASS showed no difference between the groups in the majority of outcome measures. However, female patients achieved the SANE thresholds for PASS at significantly higher rates than male patients. Patients ≥65 years old achieved ASES and Constant thresholds for MCID at significantly higher rates than patients ˂65 years old.

CONCLUSION

Most patients achieved MCID and PASS at a 2-year follow-up. Patients showed comparable rates of MCID and PASS achievement on most outcome tools based on age and gender. Female patients achieved PASS on SANE at significantly higher rates than male patients and older patients achieved MCID on ASES and Constant at higher rates than young patients. Thus, age is a stronger factor for achieving MCID than gender.

LEVEL OF EVIDENCE

Level II.