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Minimal Clinically Important Differences and Patient Acceptable Symptom State Thresholds for the QuickDASH and Boston Carpal Tunnel Questionnaire after Endoscopic Carpal Tunnel Release
Ignacio Pasqualini, MD, Shujaa Khan, MD; Youssra Marjoua, MD
Cleveland Clinic, Cleveland, OH
Background: Defining meaningful improvement after endoscopic carpal tunnel release using patient-reported outcome measures (PROMs) remains difficult. This study aimed to establish minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for the QuickDASH and Boston Carpal Tunnel Questionnaire (BCTQ) to better interpret outcomes after endoscopic release.
Methods: A prospective study was conducted involving 914 patients who underwent endoscopic carpal tunnel release between April 2018 and May 2023. Patients with bilateral release, revision surgery, or concomitant radius fracture were excluded. MCID was calculated using distribution-based methods (0.5 standard deviation of change scores), while PASS was determined using receiver operating characteristic (ROC) curve analysis.
Results: Of the 772 eligible patients, 649 (84.1%) completed baseline PROMs, and 420 (64.7%) completed 1-year follow-up. MCID thresholds were 11.07 for QuickDASH, 0.43 for BCTQ Symptom Severity Scale (SSS), and 0.45 for BCTQ Functional Status Scale (FSS). The proportion of patients achieving MCID was 85.7% for QuickDASH, 85.2% for BCTQ SSS, and 73.3% for BCTQ FSS. PASS cutoffs were ?22.5 for QuickDASH, ?2.1 for BCTQ SSS, and ?1.63 for BCTQ FSS. The percentage of patients achieving PASS was 68.3% for QuickDASH, 74.3% for BCTQ SSS, and 62.9% for BCTQ FSS.
Conclusions: This study establishes clinically meaningful MCID and PASS thresholds for the QuickDASH, SSS, and FSS in patients undergoing endoscopic carpal tunnel release. These values enhance the interpretability of PROMs, support shared decision-making, and provide objective benchmarks to assess treatment success. Their integration into clinical practice offers a more patient-centered framework for evaluating outcomes and optimizing care.
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