These authors sought to define a minimal clinically important difference (MCID) for different shoulder outcome metrics and range of motion after total shoulder arthroplasty (TSA) in 466 anatomic TSA (aTSA) and reverse TSA (rTSA) using an anchor-based method: asking the patient to rate his or her shoulder as “worse,” “unchanged,” “better,” or “much better” relative to the preoperative condition.
The anchor-based MCIDs were
Simple Shoulder Test score = 1.5 ± 0.3
Using the SST, this study showed highly respectable average I/MPI of 80% for anatomic total shoulders and an average I/MPI of 76% for reverse total shoulders.
The percentage of maximal possible improvement in the SST is easy to calculate and easily understood by patients.
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American Shoulder and Elbow Surgeons = 13.6 ± 2.3
Constant score = 5.7 ± 1.9
University of California Los Angeles Shoulder Rating Scale = 8.7 ± 0.6
Shoulder Pain and Disability Index score = 20.6 ± 2.6
Global shoulder function = 1.4 ± 0.3
Pain visual analog scale = 1.6 ± 0.3
Active abduction = 7° ± 4°
Active forward flexion = 12° ± 4°
Active external rotation = 3° ± 2°.
Female gender and rTSA were associated with lower MCID values compared with male gender and aTSA patients.
Comment: There are two important limitations to such a study.
Comment: There are two important limitations to such a study.
First, the patients' answer to the anchor question requires them to recall the condition of their shoulder prior to their surgery a long and variable time ( 44.9 ± 23.8 months (range, 24-157)) prior to the last followup.
Second, the concept of the MCID does not consider that the absolute amount of improvement (e.g. the MCID of 1.5 for the Simple Shoulder Test), may be less important than the amount of improvement expressed as a percent of the maximal possible improvement (I/MPI).
For example an improvement in the SST score by the MCID of 1.5 from a preoperative score from 0 out of 12 to a postoperative score of 2 out of 12 is an improvement of only 2/12ths or only 17% of the maximal possible improvement. Patients with a postoperative SST of 2 are rarely satisfied with the outcome of their arthroplasty (even though they improved by the MCID).
On the other hand, an improvement in the SST score by the MCID of 1.5 from a preoperative score from 8 out of 12 to a postoperative score of 10 out of 12 is an improvement of 50% of the maximal possible improvement (2/4).
Using the SST, this study showed highly respectable average I/MPI of 80% for anatomic total shoulders and an average I/MPI of 76% for reverse total shoulders.
The percentage of maximal possible improvement in the SST is easy to calculate and easily understood by patients.
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The reader may also be interested in these posts:
Healing through joint replacement
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