Validation of the Mayo Hip Score: construct validity, reliability and responsiveness to change

Although clinically relevant thresholds such as minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) have been widely described across orthopaedics, their application in hallux valgus surgery remains scarce. The purpose of this study was to determine the MCID and PASS thresholds for the visual analog scale (VAS) and Foot and Ankle Ability Measure (FAAM) scores after hallux valgus surgery. A retrospective review was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected preoperatively and 1 year postoperatively. The specific PROMs used were the FAAM-activities of daily living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. Two methods were used to calculate MCID and PASS thresholds: a distribution-based approach for MCID and an anchor-based approach using responses to a 1-year postoperative satisfaction question for PASS. The analysis identified optimal cutoff points that maximized sensitivity and specificity based on the Youden index. Overall, 86% (136/158) completed baseline PROMs, and 73% (99/136) completed 1-year PROMs. The distribution-based MCID for FAAM-ADL, SANE, and VAS were calculated to be 10.8, 14.1, and 1.2, respectively. The percentage of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for SANE, and 96% for VAS. The PASS threshold for FAAM-ADL, SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The percentage of patients who achieved PASS thresholds was 78% for FAAM-ADL, 72% for SANE, and 69% for VAS. This study identified useful values for the MCID and PASS thresholds of FAAM-ADL, SANE, and VAS scores at 1-year follow-up for patients undergoing hallux valgus surgery. Overall, despite not meeting the MCID thresholds, patients undergoing hallux valgus surgery were still likely to be satisfied with their surgery.

Background: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. Purpose: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. Results: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P < .001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, –13.8 and 78%, respectively; PROMIS-PI, –4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = −0.836), HOS-SS (r = −0.767), and iHOT-12 (r = −0.719) scores and exhibited at least moderate correlations (r≥−0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r≥−0.586). Strong correlations were seen between the hip-specific PROM scores (r≥−0.745). Conclusion: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores.

AB1165 The minimal clinically important difference (MCID) raises the significance of outcome effects above the statistical level

Study designProspective observational multicenter cohort study.ObjectivesTo determine Minimal Clinically Important Difference (MCID) of AO Spine PROST (Patient Reported Outcome Spine Trauma) and conducting a long-term prospective validation.MethodsData were collected from a prospective observational international multicenter cohort study. Adults (18-65) with acute thoracolumbar (TL) burst fractures without neurologic deficits were enrolled, and followed for up to 2 years. Patients completed the AO Spine PROST, Oswestry Disability Index (ODI), EQ-5D, and Pain NRS. Characteristics were analyzed using descriptive statistics, MCID for PROST with distribution-based approach using the standard deviation (SD) of change in scores. Floor and ceiling effects were also evaluated. Internal consistency (Cronbach's alpha, item-total correlation coefficient (ITCC) and pairwise Spearman correlation), construct validity (Pearson correlations (rs) with ODI, EQ-5D, Pain NRS), and responsiveness (effect sizes (ES) and standardized response mean (SRM)) were assessed.ResultsNinety-three patients were included. MCID for a moderate change (0.5*SD) in PROST score was 10.6. No floor or ceiling effects were observed. Internal consistency was high (Cronbach's α = 0.9-1.0 and acceptable ITCC). PROST scores strongly correlated with ODI (rs = -0.67 to -0.89; P < .001), but correlations with EQ-5D were weak (rs = -0.29 to 0.05; P > .005), except at 1-year follow-up. No consistent pattern was found with Pain NRS. Responsiveness was very good (ES = 3.2, SRM = 3.1; P < .001).ConclusionsThe AO Spine PROST identified an MCID of 10.6 as indicative of a moderate clinically meaningful change. The instrument also showed strong internal consistency, construct validity, and excellent responsiveness in long-term follow-up.

Background:Minimal clinically important difference (MCID) of a patient‐reported outcome (PRO) measure is the smallest change in the scores that is meaningful from a patient's perspective. The responsiveness, on the other hand, is an important measurement property which is required to show that the instrument is capable of detecting change over time or after a therapeutic intervention. Evaluating both responsiveness and MCID of a newly developed PRO instrument is a measurement necessity. A novel haematological malignancy (HM) specific PRO, HM‐PRO, has been developed for use in daily clinical practice as well as clinical research. The HM‐PRO is a composite measure consisting of two scales: Part A‐measuring the impact on patients’ quality of life (QoL); and Part B‐measuring the effect of signs and symptoms experienced by the patients.Aims:The aims of this study were to evaluate the responsiveness and estimate the MCID of the newly developed HM‐PRO.Methods:In a prospective multicenter cross‐sectional study, a total of 299 patients: male 167 (55.9%); mean age 64.9 (±11.5) years, range 17.9–88.5 years; mean time since diagnosis 4.9 (±4.8) years, range 0.003 – 27.4 years; with different HMs (acute lymphoid leukaemia‐8, acute myeloid leukaemia‐18, aggressive non‐Hodgkin lymphoma‐21, chronic lymphoid leukaemia‐24, chronic myeloid leukaemia‐11, Hodgkin lymphoma‐12, indolent non‐Hodgkin lymphoma‐8, myelodysplastic syndrome‐65, multiple myeloma‐85, myeloproliferative neoplasm‐47); in different disease state (stable‐139, remission‐82, progressing‐78), were recruited. Patients were asked to complete the HM‐PRO at baseline (t0) and after three months (t1). Data analysis was performed using IBM SPSS 23 statistical software. Paired t‐test, effect size (ES) and standard response mean (SRM) analysis were performed to test HM‐PRO's responsiveness as the ability to detect change. An anchor question (5‐point Likert scale from ‘much worse’ to ‘much better’) measuring change in HRQoL from patients’ perspective was used. The distribution‐based approach was employed to estimate the MCID, using standard deviation (SD) and the standard error of measurement (SEM).Results:Both parts of the HM‐PRO were assessed individually for responsiveness. The paired sample t‐test was significant in the ‘slightly better’ group for Part A (mean score change = 6.8, SD = 13.7, t = 3.343, df = 44, p = 0.002; Cohen's d = 0.35; SRM = 0.50), and Part B (mean score change = 3.68, SD = 8.7, t = 2.7, df = 42, p = 0.009; Cohen's d = 0.31; SRM = 0.42) showing significant decrease in score over time and with moderate effect size. In contrast, patient group with ‘about the same’ HRQoL did not show significant change in scores over time for both Part A (mean score change = 1.7, SD = 12.7, t = 1.7, df = 154, p = 0.09; Cohen's d = 0.08; SRM = 0.13) and Part B (mean score change = 0.57, SD = 8.93, t = 0.80, df = 153, p = 0.42; Cohen's d = 0.04; SRM = 0.06) (Table 1a). In order to establish MCID, statistical characteristics of a sample of baseline patient response were studied for both Part A and Part B. The analysis of Part A showed an SEM of 6.2 and 1/2 SD of 11.2, and for Part B showed an SEM of 5.9 and 1/2 SD of 7.3 (Table 1b).Summary/Conclusion:This study has established the responsiveness and MCID for both Part A and Part B of the HM‐PRO. The HM‐PRO is capable of detecting a small but clinically important change in patients’ HRQoL over time. The MCID for Part A based on SEM was 6.2 and for PART B 5.9 points. It would, therefore, be prudent, for practical reason, to propose an MCID of ‘6’ for the HM‐PRO.image

Treatment effectiveness following spine surgery is usually gauged with the help of patient-reported outcome (PRO) questionnaires. Although these questionnaires assess pain, disability, and general health state, their numerical scores lack direct, clinically significant meaning. Thus, the concept of minimum clinically important difference (MCID) has been introduced, which indicates the smallest change in an outcome measure that reflects clinically meaningful improvement to patients. The authors set out to determine anterior cervical discectomy and fusion (ACDF)-specific MCID values for the visual analog scale (VAS), Neck Disability Index (NDI), 12-Item Short-Form Health Survey (SF-12), and EQ-5D (the EuroQol health survey) in patients undergoing ACDF for cervical radiculopathy. Data on 69 patients who underwent ACDF for cervical radiculopathy were collected in the authors' web-based, prospective registry during the study enrollment period. Patient-reported outcome questionnaires (VAS-neck pain [NP]), VAS-arm pain [AP], NDI, SF-12, and EQ-5D) were administered preoperatively and 3 months postoperatively, allowing 3-month change scores to be calculated. Four established calculation methods were used to calculate anchor-based MCID values using the North American Spine Society (NASS) patient satisfaction scale as the anchor: 1) average change, 2) minimum detectable change (MDC), 3) change difference, and 4) receiver operating characteristic (ROC) curve analysis. Sixty-one patients (88%) were available at follow-up. At 3 months postoperatively, statistically significant improvement (p < 0.001) was observed for the following PROs assessed: VAS-NP (2.7 ± 3.3), VAS-AP (3.7 ± 3.6), NDI (23.2% ± 19.7%), SF-12 physical component score (PCS; 10.7 ± 9.7), and EQ-5D (0.20 ± 0.23 QALY). Improvement on the SF-12 mental component score (MCS) trended toward significance (3.4 ± 11.4, p = 0.07). The 4 MCID calculation methods generated a range of MCID values for each of the PROs: VAS-NP 2.6-4.0, VAS-AP 2.4-4.2, NDI 16.0%-27.6%, SF-12 PCS 7.0-12.2, SF-12 MCS 0.0-7.2, and EQ-5D 0.05-0.24 QALY. The maximum area under the curve (AUC) was observed for NDI (0.80), and the minimum AUC was observed for SF-12 MCS (0.66) and EQ-5D (0.67). Based on the MDC approach, the MCID threshold was 2.6 points for VAS-NP, 4.1 points for VAS-AP, 17.3% for NDI, 8.1 points for SF-12 PCS, 4.7 points for SF-12 MCS, and 0.24 QALY for EQ-5D. The mean improvement in patient scores at 3 months surpassed the MCID threshold for VAS-NP, NDI, and SF-12 PCS but not for VAS-AP, SF-12 MCS, and EQ-5D. The ACDF-specific MCID is highly variable depending on the calculation technique used. The MDC approach seems to be most appropriate for MCID calculations in the ACDF population, as it provided a threshold value above the 95% confidence interval of nonresponders (greater than the measurement error) and was closest to the average change of most PROs reported by responders. When the MDC method was applied with the NASS patient satisfaction scale as the anchor, the MCID thresholds were 2.6 points for VAS-NP, 4.1 points for VAS-AP, 17.3% for NDI, 8.1 points for SF-12 PCS, 4.7 points for SF-12 MCS, and 0.24 QALY for EQ-5D.

To define Minimally Clinically Important Difference (MCID) and Patient AcceptableSymptomatic State (PASS) threshold scores after open gluteus medius and/or minimus repair. Primary open gluteus medius and/or minimus repair patients from November 2013 to March 2020 were identified. Patient reported outcomes (PROs) were assessed preoperatively, 1- and 2-year follow-up, including the Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) Pain. Thresholds for achieving a MCID and PASS postoperatively were calculated using the distribution method and receiver operator curve analysis; 25 patients (24 females, 1 male, age: 69 ± 6.8 years, body mass index: 26.9 ± 5.0 kg/m2) were included in final analyses. MCID threshold scores for HOS-ADL, mHHS, iHOT-12 and VAS Pain were calculated as 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold scores for each of the PROs were as follows: HOS-ADL (71.9), mHHS (60.0), iHOT-12 (49.2) and VAS Pain (36.8). MCID thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 58.3%, 83.3%, 66.7% and 57.1% of patients, respectively. PASS thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 52.4%, 44.8%, 65% and 59.1% of patients, respectively. Open gluteus medius and/or minimus repair results in a high rate of achievement of clinically significant outcomes at a minimum of 2 years postoperatively. MCID threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 71.9, 60.0, 49.2 and 36.8, respectively. The majority of patients achieved clinically significant outcomes with 81.3% and 77.3% achieving MCID and PASS for at least one PRO, respectively.

Relevance. The consequences of acetabular fractures most often manifest as coxarthtrosis and/or aseptic necrosis of the femoral head. One of the most important issues is proper positioning of the artificial hip socket, which depends on anatomical conditions. Objective. This study aims to analyze the outcomes of total hip arthroplasty (THA) in patients with sequelae of acetabular fractures and to compare functional results depending on the complexity of acetabular component positioning. Material and Methods. Seventy patients aged 24–67 years with sequelae of acetabular fractures who underwent THA were divided into two groups: group I (31 cases), when the positioning of the acetabular component was not problematic; group II (39 cases), when the positioning of the acetabular component of the prosthesis was technically difficult. Functional outcomes were assessed in all patients 2–15 years after surgery using the Harris Hip Score (HHS). Results. Baseline HHS scores were significantly higher in group I compared with group II (55.7 ± 11.7 vs. 35.9 ± 10.4; p &lt; 0.001, two-sample t-test). Final THA outcomes were also significantly better in group I than in group II (94.3 ± 4.6 vs. 90.6 ± 8.7; p = 0.026, two-sample t-test). However, consideration of the minimal clinically important difference (MCID) for HHS indicated a clinically insignificant difference. Conclusions. Accurate restoration of anatomy, particularly the hip joint’s center of rotation, is a key success factor ensuring proper prosthesis function, stability, optimal muscle biomechanics, and implant longevity. An individualized and differentiated approach to THA in patients with sequelae of acetabular fractures allows for good and excellent anatomical and functional treatment outcomes, with the average HHS values exceeding 90 percent.

Total hip arthroplasty (THA) is a reliable operation, but it is critical that orthopaedic surgeons characterize which surgical factors influence patient-reported outcomes. The purpose of this study was to determine whether implant selection at the time of THA affects the odds of having (1) inadequate improvement according to patient-reported pain, function, and activity; (2) failure to achieve a substantial clinical benefit (SCB) with respect to pain; or (3) failure to achieve a patient-acceptable symptomatic state (PASS) according to pain and function. Prospective data were collected from 4,716 patients who underwent primary THA (from July 2015 to August 2018) in a single health-care system with standardized care pathways. Patients were categorized according to the type of femoral and acetabular components and bearing surface used. Outcomes included 1-year postoperative patient-reported outcome measures (PROMs) and improvement in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the University of California at Los Angeles (UCLA) activity score. Inadequate improvement was defined as PROMs that changed by less than the minimal clinically important difference (MCID) for the HOOS pain and physical function short form (PS) and as failure to improve beyond a mostly homebound activity status for the UCLA activity score (a score of ≤3). The MCID and SCB thresholds were set at values reported in the literature. One-year PROM data were available for 3,519 patients (74.6%). There were no differences in the proportion of patients who attained the MCID in terms of HOOS pain, HOOS PS, or UCLA activity scores at 1 year for all analyzed implant parameters. Multivariate regression demonstrated that implant selection was not a significant driver of inadequate improvement, according to HOOS pain and HOOS PS (p > 0.05). Larger (36-mm) femoral heads demonstrated lower odds of inadequate improvement versus 28-mm femoral heads according to UCLA activity scores (odds ratio [OR]: 0.64; 95% confidence interval, 0.47 to 0.86; p = 0.003). Implant-related criteria were not significant drivers of attaining a PASS or achieving an SCB with respect to HOOS pain. For the most part, THA implant characteristics are not drivers of inadequate improvement with respect to pain and function. Surgeons should utilize implants with an acceptable track record that allow stable fixation and restoration of hip biomechanics. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background/Aims The Musculoskeletal Health Questionnaire (MSK-HQ) is a patient-reported outcome measure developed for use across the spectrum of musculoskeletal diseases. This study assesses the validity of the MSK-HQ. Specifically, it analyses convergent validity, construct validity, reliability and sensitivity to change in inflammatory arthritis in a national prospective cohort, with a minimum clinically important difference (MCID) defined. Methods The study sample included patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and March 2020, with a diagnosis of inflammatory arthritis, returning a baseline PROM with at least half of the MSK-HQ items completed. Patients also completed PROMs at 3 and 12 months, contemporaneously to their clinic visits. Convergent validity was assessed in relation to the Health Assessment Questionnaire (HAQ)-II, Patient Health Questionnaire (PHQ)-4 and Disease Activity Score (DAS)-28. Construct validity was assessed using confirmatory factor analysis. Due to lack of an appropriate anchor, MCID was estimated based on two estimates for reliable change: standard error of the measurement (SEM) and one-third of a standard deviation (SD). Results A total of 13,129 patients were recruited to NEIAA, of whom 5,106 met the inclusion criteria. Of these 73% had rheumatoid arthritis, 13% psoriatic arthritis, 2% axial spondyloarthritis, and 12% undifferentiated arthritis. The MSK-HQ total score was approximately normally distributed, without floor or ceiling effects. The MSK-HQ correlated well with the HAQ-II (r = -0.79), PHQ-4 (r = -0.66) and moderately with the DAS-28 (r = -0.42). A unidimensional structure for the MSK-HQ was confirmed only when items 12 and 13, corresponding to disease understanding and self-efficacy, were excluded. The factor structure was found to be equivalent across disease subtypes with no major indications for differential item functioning. The MSK-HQ total score demonstrated good sensitivity to change with baseline to 12-month change having a large effect size (standardised response mean 1.01; 95%CI 0.95 to 1.07). This change compared well against the DAS-28 (-1.23; 95%CI -1.29 to -1.17) and was stronger than the HAQ-II (-0.62; 95%CI -0.68 to -0.56) and PHQ-4 (-0.57; 95%CI -0.63 to -0.51). MCID for the overall sample was 3.9 based on SEM and 3.6 assessed with one-third of an SD, both rounding to an integer of 4-points across the inflammatory arthritis subtypes. Conclusion This study provides evidence for the validity and sensitivity to change of the MSK-HQ in patients with inflammatory arthritis. In these patients, a change of more than 4 units is likely to be clinically meaningful. The MSK-HQ has high convergent and construct validity and is sensitive to change, providing a valuable tool for clinical care and research studies. Disclosure N. Arumalla: None. J. Galloway: Consultancies; AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. J. Ledingham: Other; BSR trustee. T. Garrood: None. S. Norton: None.

To date, no prior study has established procedure-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for anterior combined latissimus dorsi and teres major (LDTM) tendon transfer in irreparable anterosuperior rotator cuff tears (IASRCTs). This study aimed to establish these patient-centered benchmarks in a cohort with a minimum 5-year follow-up. We retrospectively reviewed 31 patients (33 shoulders) who underwent a single-stage anterior LDTM transfer for IASRCTs and completed a minimum 5-year follow-up. Patient-reported outcome measures (PROMs) included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Constant score, and activities of daily living requiring internal rotation (ADLIR) score. The MCID was calculated as one-half of the standard deviation of the change score for each PROMs. PASS thresholds were derived from receiver operating characteristic analysis, using postoperative satisfaction as the external anchor. At a mean follow-up of 83.0 ± 7.4 months, all PROMs improved significantly (P < .001). Distribution-based MCID thresholds were 10.5 (ASES), 0.9 (VAS), 10.5 (Constant), and 8.6 (ADLIR). Corresponding MCID achievement rates were 77.4%, 87.1%, 74.2%, and 87.1%, respectively. Anchor-based PASS thresholds were ASES ≥75, VAS ≤2, Constant ≥60, and ADLIR ≥78; these were achieved by 64.5%, 80.6%, 77.4%, and 71.0% of patients, respectively. Age showed a significant negative correlation with ASES MCID (r_pb = -0.53, P = .002) and ADLIR MCID (r_pb = -0.41, P = .021). Male sex correlated positively with ASES PASS attainment (φ = 0.46, P = .010). No other baseline variables were significantly associated with MCID or PASS (all P > .05). This study is the first to establish clinically meaningful MCID and PASS thresholds for anterior LDTM transfer in patients with IASRCTs at a minimum 5-year follow-up. Most patients achieved substantial improvements that were deemed acceptable by the patients. These procedure-specific benchmarks provide practical targets for clinical assessment and patient counseling and serve as reference values for future outcome research.

Background: Minimal clinically important difference (MCID) is the smallest change in an outcome, which a patient identifies as meaningful. Although the 2 most frequently applied Parkinson's disease (PD) “quality of life” questionnaires (the PDQ-39 and PDQ-8) provide encouragingly similar results, their MCID thresholds appear to be vastly different. Our aim was to calculate the MCID estimates for both PDQ-39 and PDQ-8 Summary Indices (PDQ-39-SI and PDQ-8-SI) by the utilization of both anchor- and distribution-based techniques. Methods: Nine hundred eighty-five paired investigations of 365 patients were included. Three different techniques were used simultaneously to calculate the MCID values. Results: First, we replicated the previously published results demonstrating how both PDQ-39-SI and PDQ-8-SI provide similar values and respond in a similar way to changes. Subsequently, we calculated the MCID thresholds. The most optimal estimates for MCID thresholds for PDQ-39-SI were -4.72 and +4.22 for detecting minimal clinically important improvement and worsening. For PDQ-8-SI, these estimates were -5.94 and +4.91 points for detecting minimal clinically important improvement and worsening respectively. Conclusions: Our study is the first one that directly compared the MCID estimates for both PDQ-39-SI and PDQ-8-SI on a large pool of patients including all disease severity stages. These MICD estimates varied across PD severity.

Background: Several studies have investigated failure rates and magnitude of improvement in patient-reported outcome measures after microfracture surgery for focal chondral defects of the knee; however; what constitutes clinically significant improvement in this patient population is poorly understood. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for microfracture surgery including the time-dependent nature of these thresholds and (2) identify predictors of achieving the MCID and PASS in patients specifically undergoing microfracture of the knee. Study Design: Case series; Level of evidence, 4. Methods: A secure institutional cartilage preservation repository was queried for all patients who underwent microfracture between 2004 and 2017. The distribution method was used to calculate MCID thresholds for the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), whereas an anchor-based method was used for the PASS. Multivariate logistic regressions were constructed to determine predictors of achieving the MCID and PASS. Results: A total of 206 patients with a mean ± SD age of 33.7 ± 13.2 years and body mass index of 26.9 ± 5.3 kg/m2 were included. All thresholds for the MCID and PASS increased over time except for the MCID thresholds for the KOOS Sports and Symptoms subscales. The proportion of patients who achieved the MCID (6 months, 78.4%; 12 months, 83.9%; 24 months, 88.6%) and PASS (6 months, 67.7%; 12 months, 79.2%; 24 months, 76.1%) generally increased over time. Older age and larger lesion size were negative independent predictors of MCID achievement. Older age was also a negative predictor of the PASS, whereas male sex and higher preoperative KOOS Symptoms and Pain scores were positive independent predictors of the PASS. Conclusion: The MCID and PASS thresholds for the IKDC and KOOS in patients undergoing microfracture of the knee are dynamic, with an increasing number of patients achieving the MCID over time. The percentage achieving the PASS increased between 6 and 12 months and then declined slightly at 24 months. Independent predictors of achieving the MCID were lesion size and age at surgery, whereas predictors of achieving the PASS included lesion size, male sex, and greater preoperative KOOS Symptoms and Pain scores.

BackgroundTo assess the 10-item Spine Functional Index (SFI-10) clinimetric properties in a general musculoskeletal disorder (MSD) spine population. Ascertain the psychometric characteristics’ consistency with the developmental study findings for structural and criterion validity, internal consistency, and floor/ceiling effect; establish the longitudinal characteristics for test–retest reliability, responsiveness, construct validity, and error scores; and clarify practical characteristics of readability, missing responses, and time/errors for completion/scoring related to administrative burden.MethodsA longitudinal study of deidentified spine MSD patients (n = 1317, 53.4% female, age = 18-91yrs, av = 49.5 ± 16.4yrs; neck = 36.5%, mid-back = 8.4%, low back = 56.0%, multi-site = 0.3%) who completed the SFI-10, the Patient Specific Functional Scale (PSFS), and Numerical Rating Scales for Global-function (G-NRS) and Pain (P-NRS). Structural validity used factor analysis, exploratory (EFA) and confirmatory (CFA), plus Rasch analysis. Criterion validity used Spearman's correlation coefficient (r) between the SFI-10 and criteria (PSFS, G-NRS and P-PRS) scores, and construct validity (n = 91, known-groups independent t-test). Internal consistency used Cronbach's alpha (α) and floor/ceiling effects were determined. Subgroups determined reliability (n = 104, intraclass correlation coefficient, ICC2.1); error (n = 171) through the standard error of measurement (SEM) and minimum detectable change (MDC90). Responsiveness (n = 171) was calculated using effect-size (ES), standard response mean (SRM), and area under the curve (AUC); and interpretability through the minimal clinically important difference (MCID). Practicality (n = 16) clarified missing responses, readability, and time/errors for completion/scoring.ResultsThe SFI-10’s structural validity was unequivocally one-dimensional from EFA and verified by CFA with acceptable fit-indices (chi-square/df = 2.88, CFI = 0.981, TLI = 0.975, RMSEA = 0.061), and supported by Rasch analysis (PSR = 0.79, Infit = 0.678–1.216, Outfit = 0.604–1.279, Item-difficulties = -1,215–2.488). Criterion validity varied from high (G-NRS, r = 0.60) and moderate (PSFS, r = 0.43) to low-inverse (P-NRS, r = -0.24). Internal consistency was strong (α = 0.84) and no floor/ceiling effects were present. Reliability was excellent (ICC2.1 = 0.97), responsiveness substantial (ES = 1.54; SRM = 1.64; AUC = 0.89), and measurement error robust (SEM = 3.84; MDC90 = 8.98%, MDIC = 10.4%), with construct validity confirmed (p < 0.001). Practicality showed no missing responses, completion/scoring errors < 1%, excellent readability (Grade = 5.1, Ease = 74.1%), short completion (39.2 ± 10.3 s) and scoring times (8.5 ± 1.8 s).ConclusionsThe SFI-10 demonstrates sound measurement properties in a general physiotherapy outpatient MSD spine population for both psychometric and practical characteristics. Further investigation in culturally diverse settings that include both inpatients and community settings with whole-spine and regional-spine criteria is required.

Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form–36 were evaluated in patients with neck pain