Purpose
Although the pain visual analog scale (VAS-pain) is a ubiquitous patient-reported
outcome instrument, it remains unclear how to interpret changes or differences in
scores. Therefore, our purpose was to calculate the minimal clinically important difference
(MCID) and substantial clinical benefit (SCB) for the VAS-pain instrument in a nonshoulder
hand and upper extremity postoperative population.
Methods
Adult postoperative patients treated by 1 of 5 fellowship-trained orthopedic hand
surgeons at a single tertiary academic medical center were identified. Inclusion required
VAS-pain scores at baseline (up to 3 months before surgery) and follow-up (up to 4
months after surgery), in addition to a response to a pain-specific anchor question
at follow-up. The MCID estimates were calculated with (1) the 1/2 standard deviation
method; and (2) an anchor-based approach. The SCB estimates were calculated with (1)
an anchor-based approach; and (2) a receiver operator curve method that maximized
the sensitivity and specificity for detecting a “much improved” pain status.
Results
There were 667 and 148 total patients included in the MCID and SCB analyses, respectively.
The 1/2 standard deviation MCID estimate was 1.6, and the anchor-based estimate was
1.9. The anchor-based SCB estimate was 2.2. The receiver operator curve analysis yielded
an SCB estimate of 2.6, with an area under the curve of 0.72, consistent with acceptable
discrimination.
Conclusions
We propose MCID values in the range of 1.6 to 1.9 and SCB values in the range of 2.2
to 2.6 for the VAS-pain instrument in a nonshoulder hand and upper extremity postoperative
population.
Clinical relevance
These MCID and SCB estimates may be useful for powering clinical studies and when
interpreting VAS-pain score changes or differences reported in the hand surgery literature.
These values are to be applied at a population level, and should not be applied to
assess the improvement, or lack thereof, for individual patients.
Key words
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Article info
Publication history
Published online: May 26, 2022
Accepted:
March 9,
2022
Received:
July 9,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
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