The Minimal Clinically Important Difference of the PROMIS and QuickDASH Instruments in a Nonshoulder Hand and Upper Extremity Patient Population

Abstract

The minimal clinically important difference (MCID) is used in research and clinical settings as a benchmark to gauge improvement following treatment. The purpose of this study was to provide anchor-based MCID estimates for Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy instruments in a nonshoulder hand and upper extremity population. Adult patients (≥18 years) seeking care at a tertiary academic outpatient hand surgery clinic completed patient-reported outcome measures on tablet computers between January 2015 and August 2017. Data were collected at baseline and at 6 ± 2 weeks of follow-up. The PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) Computer Adaptive Test (CAT) instruments were administered, along with the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH). A mean change anchor-based method was used to estimate MCIDs by comparing scores between anchor groups reporting no change versus slightly improved in terms of function and pain. Scores for each instrument significantly improved over the study period. With significant differences in scores between groups reporting no change and slightly improved function, anchor-based MCID estimates were calculated as follows: 2.1 for the PROMIS UE CAT, 1.7 for the PROMIS PF CAT, and 6.8 for the QuickDASH. There was no significant difference in PROMIS PI CAT scores between anchor groups when queried for level of pain improvement, precluding estimation of an anchor-based MCID. We have provided anchor-based MCID estimates for the PROMIS UE CAT, PROMIS PF CAT, and the QuickDASH for a general nonshoulder hand and upper extremity population. These values may be useful in future research for informing power calculations and when interpreting whether the magnitude of change on these instruments is clinically significant at a population level. This study provides clinicians with a reference for values that may reflect clinically meaningful changes in scores for patient-reported outcome instruments commonly utilized in the current hand surgery literature.