Malay Sunitha, Chung Kevin C
Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5340, USA.
J Hand Surg Am. 2013 Apr;38(4):652-9. doi: 10.1016/j.jhsa.2013.01.022. Epub 2013 Mar 6.
Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is an important component of outcomes research to understand treatment effectiveness from the patient's perspective. For patients with ulnar neuropathy at the elbow (UNE), these assessments are vital to examine how much change in the questionnaire scores equate to patient satisfaction.
We calculated the change in scores of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Carpal Tunnel Questionnaire (CTQ) from preoperative to 3, 6, and 12 months after ulnar nerve simple decompression procedure. We used the anchor-based approach of receiver operating characteristic curves to determine the MCID.
On average, MCID of 10, 12, and 7 points were identified for pain, function, and activities of daily living domains of the MHQ. Similarly, DASH, CTQ-symptom severity scale, and CTQ-function severity scale had an average MCID of 7, 0.7, and 0.3, points respectively. At the 3, 6, and 12 months' time points, an MCID of 9, 8, and 13 points for pain; 12, 12, and 12 points for function; and 6, 8, and 6 points for activities of daily living domains of the MHQ were identified; similarly an MCID of 8, 7, and 7 points for DASH; 0.4, 0.7, and 0.7 points for CTQ-symptom severity scale; and 0.3, 0.3, and 0.4 points for CTQ-function severity scale were established.
The smaller MCIDs of MHQ, DASH, and even smaller MCIDs of CTQ found in our study indicate that a small change in the scores identified satisfied patients. Simple decompression surgery for UNE produced patient satisfaction with only a small change in their questionnaire scores. The implications of this finding are that simple decompression surgery for UNE is a highly effective procedure and that the outcomes questionnaires used are highly responsive, which minimizes sample size requirements for future research studies relating to UNE.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
确定患者报告结局问卷的最小临床重要差异（MCID）是结局研究的重要组成部分，有助于从患者角度理解治疗效果。对于肘部尺神经病变（UNE）患者，这些评估对于检验问卷分数的变化与患者满意度之间的关系至关重要。
我们计算了尺神经单纯减压术后3个月、6个月和12个月时，密歇根手部结局问卷（MHQ）、手臂、肩部和手部功能障碍（DASH）问卷以及腕管综合征问卷（CTQ）的术前至术后分数变化。我们采用基于锚点的受试者工作特征曲线方法来确定MCID。
平均而言，MHQ的疼痛、功能和日常生活活动领域的MCID分别为10分、12分和7分。同样，DASH、CTQ症状严重程度量表和CTQ功能严重程度量表的平均MCID分别为7分、0.7分和0.3分。在3个月、6个月和12个月的时间点，MHQ的疼痛、功能和日常生活活动领域的MCID分别为9分、8分和13分；功能分别为12分、12分和12分；日常生活活动领域分别为6分、8分和6分；同样，DASH的MCID分别为8分、7分和7分；CTQ症状严重程度量表分别为0.4分、0.7分和0.7分；CTQ功能严重程度量表分别为0.3分、0.3分和0.4分。
我们的研究发现，MHQ和DASH的MCID较小，CTQ的MCID更小，这表明分数的微小变化就能使患者满意。UNE的单纯减压手术仅使问卷分数有微小变化，却能让患者满意。这一发现的意义在于，UNE的单纯减压手术是一种高效的手术，所使用的结局问卷具有高度敏感性，这将减少未来UNE相关研究的样本量需求。
研究类型/证据水平：治疗性研究II级。
