1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
2 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Foot Ankle Int. 2019 Jun;40(6):687-693. doi: 10.1177/1071100719834539. Epub 2019 Mar 6.
Minimum clinically important difference (MCID) defines a threshold when determining clinically significant treatment improvement. Visual analog scale (VAS) and Foot and Ankle Ability Measure activities of daily living (FAAM-ADL) are commonly used for measuring hallux valgus correction. This study aimed to determine MCID in VAS pain and FAAM-ADL scores for hallux valgus correction and additionally, to identify variables influencing achievement of the VAS pain MCID.
Patients undergoing hallux valgus surgery were retrospectively included. VAS pain, FAAM-ADL, and pain satisfaction surveys were collected preoperatively and minimum 1-year postoperatively. Using a 6-point Likert-type pain satisfaction scale, patients reporting low postoperative satisfaction scores 1 through 3 were categorized as "dissatisfied," and high satisfaction scores 4 through six as "satisfied." One distribution-based method and 2 anchor-based methods were used to calculate MCID. Further, a logistic regression was calculated to determine if one group (defined by sex, pain satisfaction, preoperative VAS pain, concomitant lesser toe deformity correction, and specific hallux valgus correction procedure) had a greater likelihood of achieving the VAS pain MCID threshold. This study included 170 patients with postoperative follow-up averaging 23.6 months.
Calculated MCID scores ranged from 1.8 to 5.2 points for VAS pain and 11.1 to 22.7 points for FAAM-ADL. Moderate deformity correction with proximal first metatarsal osteotomy (Ludloff) (OR=2.236, P = .036) or severe deformity correction with first tarsometatarsal arthrodesis (Lapidus) (OR=3.145, P = .046); and higher preoperative pain scores (OR=1.045, P < .010) had significantly higher odds of meeting VAS pain MCID.
This study demonstrated MCID values that may indicate significant pain and function improvement after hallux valgus correction. Higher preoperative pain, and utilization of proximal metatarsal osteotomy or first tarsometatarsal arthrodesis for moderate or severe deformity correction resulted in significantly greater likelihood of reaching the VAS pain MCID than utilizing distal metatarsal and/or proximal phalanx osteotomy for mild deformity treatment.
Level IV, validating outcome measures.
最小临床重要差异（MCID）定义了确定临床显著治疗改善的阈值。视觉模拟评分（VAS）和足踝能力日常生活活动（FAAM-ADL）常用于测量拇外翻矫正。本研究旨在确定 VAS 疼痛和 FAAM-ADL 评分在拇外翻矫正中的 MCID，并确定影响 VAS 疼痛 MCID 实现的变量。
回顾性纳入接受拇外翻手术的患者。收集术前和术后至少 1 年的 VAS 疼痛、FAAM-ADL 和疼痛满意度调查。使用 6 分李克特式疼痛满意度量表，报告术后满意度评分 1 至 3 的患者归类为“不满意”，评分 4 至 6 的患者归类为“满意”。使用 1 种基于分布的方法和 2 种基于锚定的方法计算 MCID。此外，计算逻辑回归以确定一组（根据性别、疼痛满意度、术前 VAS 疼痛、伴发小趾畸形矫正和特定拇外翻矫正程序定义）是否更有可能达到 VAS 疼痛 MCID 阈值。本研究纳入了 170 例术后平均随访 23.6 个月的患者。
VAS 疼痛的计算 MCID 评分范围为 1.8 至 5.2 分，FAAM-ADL 的 MCID 评分范围为 11.1 至 22.7 分。中度畸形矫正采用第一跖骨近端截骨术（Ludloff）（OR=2.236，P=.036）或重度畸形矫正采用第一跖楔关节融合术（Lapidus）（OR=3.145，P=.046）；术前疼痛评分较高（OR=1.045，P<.010）的患者达到 VAS 疼痛 MCID 的可能性显著更高。
本研究表明，拇外翻矫正后疼痛和功能改善可能具有 MCID 值。较高的术前疼痛以及对中度或重度畸形矫正采用第一跖骨近端截骨术或第一跖楔关节融合术，与对轻度畸形治疗采用第一跖骨远端和/或近节趾骨截骨术相比，显著增加达到 VAS 疼痛 MCID 的可能性。
IV 级，验证结局指标。
