Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses: A Systematic Review.
Dominique I Dabija, Nitin B Jain
PMID 31318747WHAT IT FOUND
The smallest score change considered important on common shoulder outcome measures varies widely by diagnosis.
Do not apply one fixed threshold to all shoulder patients; match the value to rotator cuff, fracture, instability, or arthroplasty status.
Key findings
01Reported ASES MCID values varied by shoulder diagnosis, with 6.2 to 17, 17.9, 21.9, and 26.9 for rotator cuff disease and 6.3 to 13.6 and 20.9 after arthroplasty.
02SPADI MCID values reported were 8, 10, and 13.2, while values after shoulder arthroplasty were 14.1 and 20.6.
03Some MCID values in the review were not diagnosis-specific because ten studies either did not specify shoulder disorders or calculated a single MCID for multiple disorders.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only overall MCID results were included, so subgroup values that may matter for specific patient groups were left out. Some included studies combined patients who improved and patients who worsened in anchor-based MCID calculations, while others included only improved patients, which can change the reported threshold. Ten studies did not specify shoulder disorders or calculated a single MCID for multiple disorders, so some values may not apply to a diagnosis-specific patient. The review excluded non-English translated outcome instruments, so values may not transfer to other language versions. The authors note that no MCID calculation method is a gold standard and that method and population heterogeneity likely produced wide ranges. Study quality varied, with MINORS scores from 9 to 15 of 16. The search stopped in March 2018, so later values are not included.
Declared interests
Funding support is listed as N.I.H., Extramural. The supplied article text does not include a conflict-of-interest declaration.
The easy way to misread this
Do not read any single MCID value as the universal threshold for all shoulder patients. The review found wide ranges that changed with diagnosis and calculation method, and some studies combined or did not specify diagnoses.