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American Association for Hand Surgery

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Is the Current Minimal Clinically Importance Difference for Patient Reported Outcome Measures following Carpal Tunnel Release Relevant?
Eric X Jiang, MD1, Michael A Korn, MD1, Jessi A Fore, BA2, Maxwell T. Yoshida, BS1, Jacob R. Kalkman, B.S.3 and Charles S Day, MD, MBA1, (1)Henry Ford Health System, Detroit, MI, (2)Oakland University William Beaumont School of Medicine, Rochester, MI, (3)Wayne State University School of Medicine, Detroit, MI

HYPOTHESIS
In the context of carpal tunnel release (CTR), minimal clinically important difference (MCID) for Patient Reported Outcomes Measurement Information System (PROMIS) scores has been exclusively described using distribution-based (DB) calculations, despite literature in other orthopaedic fields suggesting significant differences between DB and anchor-based (AB) MCID values differing up to 100% (1,2,3,4,5). %. The purpose of this study was to calculate and compare DB and AB MCID values for PROMIS Upper Extremity (UE) Computer Adaptive Test (CAT), Pain Interference (PI) CAT, and QuickDASH scores following CTR.

METHODS
Retrospective chart review was performed on patients who underwent unilateral CTR at a midwest, multicenter hospital system. Data collection included demographics, preoperative and postoperative PROMIS UE, PI, and QuickDASH scores, and a response to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). DB MCID was calculated using 0.5*standard deviation of preoperative scores. AB MCID was calculated by the difference in mean change in scores from the baseline category of "slightly worse/no change/slightly improved" to "improved" category.

RESULTS
Data from 53 unique patients undergoing CTR were analyzed. The mean age was 57.4 years and 36 patients were female (68%). The majority of responses for all three domains fell into the improved category (Table 1). For PROMIS UE, the DB and AB MCID were 4.2 and 3.0, respectively; for PROMIS PI, the DB and AB MCID were 3.7 and 2.1, respectively; for QuickDASH, the DB and AB MCID were 9.2 and 5.4 respectively (Table 2).

CONCLUSIONS
Based on our patient sample, the DB MCID values for PROMIS UE, PI and QuickDASH after CTR are comparable to the values previously reported in the literature. AB MCID values can differ significantly from the distribution-based values for these patient reported outcome measures which suggests that patients may perceive a smaller change in their post-operative scores as significant than previously thought.


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