Editor's Choice| Volume 45, ISSUE 5, P399-407.e6, May 2020

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

Published:January 16, 2020DOI:


      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.

      Clinical relevance

      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.

      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


      1. Deutsch L. Smith L. Gage B. Kelleher C. Garfinkel D. Patient-Reported Outcomes in Performance Measurement: Commissioned Paper on PRO-Based Performance Measures for Healthcare Accountable Entities. National Quality Forum, Washington, DC2012
        • 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
        • 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
        • 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
        • Wright A.
        • Hannon J.
        • Hegedus E.J.
        • Kavchak A.E.
        Clinimetrics corner: a closer look at the minimal clinically important difference (MCID).
        J Man Manip Ther. 2012; 20: 160-166
        • Jaeschke R.
        • Singer J.
        • Guyatt G.H.
        Measurement of health status. Ascertaining the minimal clinically important difference.
        Control Clin Trials. 1989; 10: 407-415
        • McGlothlin A.E.
        • Lewis R.J.
        Minimal clinically important difference: defining what really matters to patients.
        JAMA. 2014; 312: 1342-1343
        • Bernstein D.N.
        • Houck J.R.
        • Mahmood B.
        • Hammert W.C.
        Minimal clinically important differences for PROMIS Physical Function, Upper Extremity, and Pain Interference in carpal tunnel release using region- and condition-specific PROM tools.
        J Hand Surg Am. 2019; 44: 635-640
        • Kazmers N.H.
        • Hung M.
        • Bounsanga J.
        • Voss M.W.
        • Howenstein A.
        • Tyser A.R.
        Minimal clinically important difference after carpal tunnel release using the PROMIS platform.
        J Hand Surg Am. 2019; 44: 947-953.e1
        • Sandvall B.
        • Okoroafor U.C.
        • Gerull W.
        • Guattery J.
        • Calfee R.P.
        Minimal clinically important difference for PROMIS Physical Function in patients with distal radius fractures.
        J Hand Surg Am. 2019; 44: 454-459.e1
        • Beaton D.E.
        • Wright J.G.
        • Katz J.N.
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Bone Joint Surg Am. 2005; 87: 1038-1046
        • Gershon R.C.
        • Rothrock N.
        • Hanrahan R.
        • Bass M.
        • Cella D.
        The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research.
        J Appl Meas. 2010; 11: 304-314
        • Rose M.
        • Bjorner J.B.
        • Gandek B.
        • Bruce B.
        • Fries J.F.
        • Ware J.E.
        The PROMIS Physical Function item bank was calibrated to a standardized metric and shown to improve measurement efficiency.
        J Clin Epidemiol. 2014; 67: 516-526
        • Cook C.E.
        Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense.
        J Man Manip Ther. 2008; 16: E82-E83
        • Revicki D.
        • Hays R.D.
        • Cella D.
        • Sloan J.
        Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes.
        J Clin Epidemiol. 2008; 61: 102-109
        • Mukaka M.M.
        Statistics corner: a guide to appropriate use of correlation coefficient in medical research.
        Malawi Med J. 2012; 24: 69-71
        • Hinkle D.
        • Wiersma W.
        • Jurs S.
        Applied Statistics for the Behavioral Sciences.
        Houghton Mifflin, Boston2003
        • Hossain F.S.
        • Konan S.
        • Patel S.
        • Rodriguez-Merchan E.C.
        • Haddad F.S.
        The assessment of outcome after total knee arthroplasty: are we there yet?.
        Bone Joint J. 2015; 97-B: 3-9
        • Cella D.
        • Riley W.
        • Stone A.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
      2. Healthmeasures—interpret scores: PROMIS. Northwestern University; 2019. February 11, 2019.
        (Available at:)
        • Thissen D.
        • Liu Y.
        • Magnus B.
        • et al.
        Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.
        Qual Life Res. 2016; 25: 13-23
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • 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
        • Beaton D.E.
        • van Eerd D.
        • Smith P.
        • et al.
        Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability.
        J Clin Epidemiol. 2011; 64: 487-496
        • Terwee C.B.
        • Roorda L.D.
        • Dekker J.
        • et al.
        Mind the MIC:large variation among populations and methods.
        J Clin Epidemiol. 2010; 63: 524-534
        • Ostelo R.W.
        • Deyo R.A.
        • Stratford P.
        • et al.
        Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change.
        Spine (Phila Pa 1976). 2008; 33: 90-94