Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2018 Apr;27(4):579-584. doi: 10.1016/j.jse.2017.10.032. Epub 2017 Dec 15.
The minimal clinically important difference (MCID) is the threshold value for a change that would be considered meaningful by the patient. The purpose of this study was to determine the MCIDs for the Rowe score and the Western Ontario Shoulder Instability Index (WOSI) score after arthroscopic repair of anterior shoulder instability.
The study enrolled 198 patients who underwent an arthroscopic stabilization procedure for anterior shoulder instability. Patients were assigned to no change and minimal change groups by a 15-item questionnaire at the 1-year postoperative visit. The Rowe and WOSI scores were assessed preoperatively and at a 1-year postoperative follow-up. The MCID was calculated using an anchor-based method and a distribution-based method.
There were 9 patients in the no change group and 26 patients in the minimal change group. The MCID for the Rowe score was 9.7 according to the anchor-based method. By the anchor-based method, the authors could not calculate MCID for the WOSI score because of insignificant difference of the mean score changes between the no change and minimal change groups. By the distribution-based method, MCIDs for the Rowe and the WOSI scores were 5.6 and 151.9 with the standard deviation-based estimate and 2.2 and 60.7 with the effect size-based estimate, respectively.
To assess the effectiveness of an arthroscopic stabilization procedure for anterior shoulder instability using the Rowe score, a difference of at least 9.7 in the score is clinically relevant. To compare clinical outcomes between different modalities, we should consider not only statistically significant differences but also the MCID.
最小临床重要差异（MCID）是患者认为有意义的变化阈值。本研究旨在确定关节镜修复肩前不稳定后罗氏评分和西部安大略肩不稳定指数（WOSI）评分的 MCID。
本研究纳入了 198 例接受关节镜稳定术治疗肩前不稳定的患者。患者在术后 1 年的随访中通过 15 项问卷调查被分为无变化组和最小变化组。术前和术后 1 年评估罗氏评分和 WOSI 评分。使用锚定法和分布法计算 MCID。
无变化组有 9 例，最小变化组有 26 例。根据锚定法，罗氏评分的 MCID 为 9.7。由于无变化组和最小变化组之间的平均评分变化无显著差异，因此根据锚定法无法计算 WOSI 评分的 MCID。根据分布法，罗氏评分和 WOSI 评分的 MCID 分别为 5.6 和 151.9（基于标准差的估计）和 2.2 和 60.7（基于效应量的估计）。
为了使用罗氏评分评估关节镜治疗肩前不稳定的疗效，评分至少应相差 9.7 分才有临床意义。为了比较不同治疗方式的临床结果，我们不仅应考虑统计学上的显著差异，还应考虑 MCID。
