Editor's choice| Volume 44, ISSUE 11, P947-953.e1, November 2019

Minimal Clinically Important Difference After Carpal Tunnel Release Using the PROMIS Platform


      In light of recently-proposed quality measures for carpal tunnel release (CTR), elucidating the minimal clinically important difference (MCID) for selected outcome measures will be important when interpreting treatment responses. Our purpose was to estimate the MCID of the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the short Disabilities of the Arm, Shoulder, and Hand (QuickDASH) following CTR.


      Adult patients undergoing isolated unilateral CTR between July 2014 and October 2016 were identified. Outcomes included the PROMIS Upper Extremity (UE) Computer Adaptive Test (CAT), Physical Function (PF) CAT, QuickDASH, and Pain Interference (PI) CAT. For inclusion, pretreatment baseline (within 60 days of surgery) and postoperative (6–90 days) UE or PF CAT scores were required, as well as a response on a 5-point Likert scale to the question “How much relief and/or improvement do you feel you have experienced as a result of your treatment?” The MCID was calculated using SD and minimum detectable change (MDC) distribution methods.


      In response to the Likert scale question, 88.6% of patients reported improvement at a mean of 14.8 days after surgery. The infrequency of patients reporting no change (5 of 44; 11.4%) precluded calculation of a statistically sound anchor-based MCID value. The MCID values, as calculated using the one-half SD method, were 3.6, 4.6, 10.4, and 3.4 for the UE CAT, PF CAT, QuickDASH, and PI CAT, respectively.


      We have calculated MCID values for the UE CAT, PF CAT, QuickDASH, and PI CAT for patients undergoing CTR. Although the small number of patients reporting no change and minimal change after surgery precluded an anchor-based MCID calculation, we report estimates using the one-half SD method for the MCID following CTR.

      Clinical relevance

      These MCID estimates will be helpful when interpreting CTR clinical outcomes and for powering prospective trials.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hand Surgery Quality Consortium
        Candidate quality measures for hand surgery.
        J Hand Surg Am. 2017; 42: 859-866.e3
        • Atroshi I.
        • Gummesson C.
        • Johnsson R.
        • Ornstein E.
        • Ranstam J.
        • Rosen I.
        Prevalence of carpal tunnel syndrome in a general population.
        JAMA. 1999; 282: 153-158
        • Ferry S.
        • Pritchard T.
        • Keenan J.
        • Croft P.
        • Silman A.J.
        Estimating the prevalence of delayed median nerve conduction in the general population.
        Br J Rheumatol. 1998; 37: 630-635
        • Hudak P.L.
        • Amadio P.C.
        • Bombardier C.
        Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).
        Am J Ind Med. 1996; 29: 602-608
        • Cella D.
        • Yount S.
        • Rothrock N.
        • et al.
        The patient-reported outcomes measurement information system (PROMIS): progress of an NIH roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-S11
        • Brodke D.J.
        • Saltzman C.L.
        • Brodke D.S.
        PROMIS for orthopaedic outcomes measurement.
        J Am Acad Orthop Surg. 2016; 24: 744-749
        • Beckmann J.T.
        • Hung M.
        • Voss M.W.
        • Crum A.B.
        • Bounsanga J.
        • Tyser A.R.
        Evaluation of the patient-reported outcomes measurement information system upper extremity computer adaptive test.
        J Hand Surg Am. 2016; 41: 739-744.e4
      1. Northwestern University, HealthMeasures. PROMIS. 2019. Available at: Accessed January 25, 2019.

        • Leite J.C.
        • Jerosch-Herold C.
        • Song F.
        A systematic review of the psychometric properties of the boston carpal tunnel questionnaire.
        BMC Musculoskelet Disord. 2006; 7: 78
        • Magasi S.
        • Ryan G.
        • Revicki D.
        • et al.
        Content validity of patient-reported outcome measures: perspectives from a PROMIS meeting.
        Qual Life Res. 2012; 21: 739-746
        • Tyser A.R.
        • Beckmann J.
        • Franklin J.D.
        • et al.
        Evaluation of the PROMIS physical function computer adaptive test in the upper extremity.
        J Hand Surg Am. 2014; 39: 2047-2051.e4
        • Doring A.C.
        • Nota S.P.
        • Hageman M.G.
        • Ring D.C.
        Measurement of upper extremity disability using the patient-reported outcomes measurement information system.
        J Hand Surg Am. 2014; 39: 1160-1165
        • Beleckas C.M.
        • Padovano A.
        • Guattery J.
        • Chamberlain A.M.
        • Keener J.D.
        • Calfee R.P.
        Performance of patient-reported outcomes measurement information system (PROMIS) upper extremity (UE) versus physical function (PF) computer adaptive tests (CATs) in upper extremity clinics.
        J Hand Surg Am. 2017; 42: 867-874
        • Kazmers N.H.
        • Hung M.
        • Rane A.A.
        • Bounsanga J.
        • Weng C.
        • Tyser A.R.
        Association of physical function, anxiety, and pain interference in nonshoulder upper extremity patients using the promis platform.
        J Hand Surg Am. 2017; 42: 781-787
        • Sorensen A.A.
        • Howard D.
        • Tan W.H.
        • Ketchersid J.
        • Calfee R.P.
        Minimal clinically important differences of 3 patient-rated outcomes instruments.
        J Hand Surg Am. 2013; 38: 641-649
        • London D.A.
        • Stepan J.G.
        • Calfee R.P.
        Determining the Michigan hand outcomes questionnaire minimal clinically important difference by means of three methods.
        Plast Reconstr Surg. 2014; 133: 616-625
        • Polson K.
        • Reid D.
        • McNair P.J.
        • Larmer P.
        Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire.
        Man Ther. 2010; 15: 404-407
        • Franchignoni F.
        • Vercelli S.
        • Giordano A.
        • Sartorio F.
        • Bravini E.
        • Ferriero G.
        Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39
        • Hagg O.
        • Fritzell P.
        • Nordwall A.
        • Swedish Lumbar Spine Study Group
        The clinical importance of changes in outcome scores after treatment for chronic low back pain.
        Eur Spine J. 2003; 12: 12-20
        • Copay A.G.
        • Subach B.R.
        • Glassman S.D.
        • Polly Jr., D.W.
        • Schuler T.C.
        Understanding the minimum clinically important difference: a review of concepts and methods.
        Spine J. 2007; 7: 541-546
        • Ring D.
        • Kadzielski J.
        • Fabian L.
        • Zurakowski D.
        • Malhotra L.R.
        • Jupiter J.B.
        Self-reported upper extremity health status correlates with depression.
        J Bone Joint Surg Am. 2006; 88: 1983-1988
        • Roh Y.H.
        • Noh J.H.
        • Oh J.H.
        • Gong H.S.
        • Baek G.H.
        To what degree do pain-coping strategies affect joint stiffness and functional outcomes in patients with hand fractures?.
        Clin Orthop Relat Res. 2015; 473: 3484-3490
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Katz P.
        • Morris A.
        • Trupin L.
        • Yazdany J.
        • Yelin E.
        Disability in valued life activities among individuals with systemic lupus erythematosus.
        Arthritis Rheum. 2008; 59: 465-473
        • Ho B.
        • Houck J.R.
        • Flemister A.S.
        • et al.
        Preoperative PROMIS scores predict postoperative success in foot and ankle patients.
        Foot Ankle Int. 2016; 37: 911-918
        • Asher A.L.
        • Kerezoudis P.
        • Mummaneni P.V.
        • et al.
        Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the quality outcomes database.
        Neurosurg Focus. 2018; 44: E2
        • Mintken P.E.
        • Glynn P.
        • Cleland J.A.
        Psychometric properties of the shortened disabilities of the arm, shoulder, and hand questionnaire (QuickDASH) and numeric pain rating scale in patients with shoulder pain.
        J Shoulder Elbow Surg. 2009; 18: 920-926
        • Yost K.J.
        • Eton D.T.
        • Garcia S.F.
        • Cella D.
        Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients.
        J Clin Epidemiol. 2011; 64: 507-516
        • Eton D.T.
        • Cella D.
        • Yost K.J.
        • et al.
        A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale.
        J Clin Epidemiol. 2004; 57: 898-910
        • Amtmann D.
        • Kim J.
        • Chung H.
        • Askew R.L.
        • Park R.
        • Cook K.F.
        Minimally important differences for patient reported outcomes measurement information system pain interference for individuals with back pain.
        J Pain Res. 2016; 9: 251-255
        • Chen C.X.
        • Kroenke K.
        • Stump T.E.
        • et al.
        Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials.
        Pain. 2018; 159: 775-782
        • Vranceanu A.M.
        • Jupiter J.B.
        • Mudgal C.S.
        • Ring D.
        Predictors of pain intensity and disability after minor hand surgery.
        J Hand Surg Am. 2010; 35: 956-960
        • Das De S.
        • Vranceanu A.M.
        • Ring D.C.
        Contribution of kinesophobia and catastrophic thinking to upper-extremity–specific disability.
        J Bone Joint Surg Am. 2013; 95: 76-81
        • de Moraes V.Y.
        • Godin K.
        • Tamaoki M.J.
        • Faloppa F.
        • Bhandari M.
        • Belloti J.C.
        Workers' compensation status: Does it affect orthopaedic surgery outcomes? A meta-analysis.
        PLoS One. 2012; 7e50251
        • Duncan S.F.
        • Calandruccio J.H.
        • Merritt M.V.
        • Crockarell J.R.
        • Kakinoki R.
        A comparison of workers' compensation patients and nonworkers' compensation patients undergoing endoscopic carpal tunnel release.
        Hand Surg. 2010; 15: 75-80
        • Straub T.A.
        Endoscopic carpal tunnel release: a prospective analysis of factors associated with unsatisfactory results.
        Arthroscopy. 1999; 15: 269-274
        • Cook C.E.
        Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense.
        J Man Manip Ther. 2008; 16: E82-E83
        • Crosby R.D.
        • Kolotkin R.L.
        • Williams G.R.
        Defining clinically meaningful change in health-related quality of life.
        J Clin Epidemiol. 2003; 56: 395-407
        • Calfee R.
        • Chu J.
        • Sorensen A.
        • Martens E.
        • Elfar J.
        What is the impact of comorbidities on self-rated hand function in patients with symptomatic trapeziometacarpal arthritis?.
        Clin Orthop Relat Res. 2015; 473: 3477-3483
        • Ozer K.
        • Malay S.
        • Toker S.
        • Chung K.C.
        Minimal clinically important difference of carpal tunnel release in diabetic and nondiabetic patients.
        Plast Reconstr Surg. 2013; 131: 1279-1285