Purpose
Uncertainty exists about what change in Patient-Reported Outcomes Measurement Information
System (PROMIS) scores represents a clinically relevant improvement (minimal clinically
important difference [MCID]) in hand surgery care. Using a region-specific patient-reported
outcome measure (PROM) (Michigan Hand Question [MHQ]) and a condition-specific PROM
(Boston Carpal Tunnel Questionnaire [BCTQ]), MCID values were determined for PROMIS
Physical Function (PF), Upper Extremity (UE), and Pain Interference (PI) computerized
adaptive testing among patients undergoing carpal tunnel release (CTR).
Methods
Patients undergoing CTR with a single surgeon from November 2014 to April 2017 were
asked to complete the BCTQ, MHQ, and PROMIS PF, UE, and PI at each visit. Patients
who had completed questionnaires both at a preoperative and either a 6-week or a 3-month
postoperative visit were included. The PROMIS PF, UE, and PI MCID values were calculated
using previously determined MCID estimates in the literature with both region- (ie,
MHQ) and condition-specific (ie, BCTQ) PROM anchors. The PROMIS domain MCID estimates
were also determined using the distribution-based method.
Results
A total of 70 patients fit our inclusion criteria. Using MHQ Function and Pain, PROMIS
UE, PF, and PI MCIDs were 6.3, 1.8, and –8.9, respectively. Using the average of the
2 BCTQ domains, PROMIS UE, PF, and PI MCIDs were 8.0, 2.8, and –9.7, respectively.
Using the distribution-based method, PROMIS UE, PF, and PI MCIDs were 4.2, 2.7, and –4.1,
respectively.
Conclusions
Using region- and condition-specific PROMs, we were able to provide MCID estimates
of PROMIS UE, PF, and PI for patients undergoing CTR.
Clinical relevance
Estimating PROMIS UE, PF, and PI MCIDs in CTR using validated region- and condition-specific
PROMs provides hand surgeons a way to evaluate CTR outcomes not previously described
in the literature. Surgeons should understand that these values are only estimates
and future work is needed to verify whether they reflect clinical improvement.
Key words
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Article info
Publication history
Published online: May 21, 2019
Accepted:
April 18,
2019
Received:
September 4,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
