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Minimum Clinically Important Difference in Operative Treatment of CMC Arthritis: Do Patients Expectations Change with Time?
Rebekah M Kleinsmith, MD
1; Haley D Puckett, MD
1; Stephen A Doxey, DO
1; Andrew C Sibley, BS
2; Jeffrey B Husband, MD
1; Brian P Cunningham, MD
31TRIA Orthopedic Center, Bloomington, MN; 2Orthopaedics, University of Minnesota, Minneapolis, MN; 3Park Nicollet Methodist Hospital, Minneapolis, MN
IntroductionWith hundreds of patient-reported outcome measures (PROMs) available to orthopaedic surgeons, it can be difficult to determine significance of each. The minimum clinically important difference (MCID) provides an objective way of determining the point at which outcome score changes are clinically significant. In carpometacarpal (CMC) arthritis, the MCID for the patient-reported wrist/hand evaluation (PRWHE) has been reported to be 4 to 14 for non-operative management, however, there is a lack of literature on MCID of PRWHE after operative management of CMC arthritis.
MethodsA total of 174 patients met inclusion criteria for this study. All patients that received primary operative management for CMC arthritis between April 2018-December 2022 were eligible. Exclusion criteria included incomplete PROMs at baseline, 6-weeks, 3-months or 6-months postoperatively, as well as concomitant procedures or revision procedures. All patient and surgical characteristics were obtained from a retrospective review of each patient's electronic medical record. PROMs were collected prospectively and then pulled from the electronic data capture database for the purpose of this study. MCID from baseline to each timepoint was determined by the PROMIS10 anchoring method previously described in the literature.
ResultsA total of 174 patients were included in this study; 123 (70.7%) were female. The average patient age on procedure date was 63.6 ± 7.3. The average baseline PRWHE was 62.2 ± 18.4 with an average decrease of 44.1 ± 23.0 over the 6-month follow-up period. At 6-weeks postoperatively, the calculated MCID was -13.8 with 94 (54.0%) of the patients meeting the MCID. At 3-months, 74 patients (42.5%) met the MCID of -33.1, and at 6-months 100 patients (57.5%) met the MCID of -41.5 (Figure 1). Age, sex, operating surgeon, dominance of operative hand, and smoking status were not associated with MCID attainment at any timepoint (p > 0.214).
ConclusionsMCID changes over time after operative treatment of CMC arthritis as patient expectations change. Though it is a useful tool for identifying clinically significant outcomes in practice, it is important to acknowledge and account for this variation when counseling patients.
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