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American Association for Hand Surgery

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Minimal Clinically Important Difference for PROMIS Physical Function and Pain Interference in Patients Following Surgical Treatment of Distal Radius Fracture
Alex M Hollenberg, BS, University of Rochester, Rochester, NY and Warren C Hammert, MD, Department of Orthopaedics, University of Rochester, Rochester, NY

Introduction: The Patient Reported Outcomes Measurement Information System (PROMIS) is increasingly being utilized to evaluate outcomes following hand/wrist procedures. To understand the clinical implications of postoperative score changes over time, one must estimate the minimal clinically important difference (MCID), which represents the smallest change in an outcome score that a patient may perceive as clinically beneficial. Here, we estimated the MCID for the PROMIS Physical Function (PF) and Pain Interference (PI) instruments in patients surgically treated for distal radius fracture (DRF).

Materials & Methods: Patients treated between November 2017 and November 2020 with open reduction and internal fixation for isolated DRF were identified. Demographic and patient-reported outcome data were extracted from the electronic health record. Outcomes of interest were PROMIS PF (v1.2/v2.0) and PI (v1.1) t-scores. Patients met inclusion criteria if: 1) PROMIS PF and PI scores were available at a preoperative (< 21 days before surgery) and postoperative (< 365 days after surgery) visit, and 2) a postoperative clinical anchor question asking about overall response to treatment was answered. An anchor-based MCID estimate was determined by calculating the average score change in PROMIS PF and PI for patients who responded "mild improvement" to the anchor question. A distribution-based MCID estimate was also calculated using the standard error of measurement and effect sizes of change.

Results: The change in PROMIS PF and PI scores were significantly different between patients who responded "much improvement" (n = 69), "mild improvement" (n = 39), and "no improvement" (n = 35) to the clinical anchor question (p < 0.05). The average score change in the mild improvement group for PROMIS PF and PI was 5.0 (SD 4.8) and -6.2 (SD 5.6), respectively, representing our anchor-based MCID estimates. The PROMIS PF anchor-based estimate was weakly correlated with time between visits (r = 0.34). The PROMIS PI anchor-based estimate was moderately correlated with preoperative score (r = -0.40), time between visits (r = -0.47), and age (r = 0.43). The distribution-based MCID estimate was 4.1 (SD 1.6) and -3.2 (SD 1.6) for PROMIS PF and PI, respectively.

Conclusions: Using anchor- and distribution-based methods, we estimated the range of MCID values for PROMIS PF (4.1 to 5.0 points) and PI (-3.2 to -6.2 points) for patients surgically treated for DRF.

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