From the Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee (DID); Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (NBJ); and Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (NBJ).
Am J Phys Med Rehabil. 2019 Aug;98(8):671-676. doi: 10.1097/PHM.0000000000001169.
Patient-reported outcome scales determine response to treatment. The minimal clinically important difference of these scales is a measure of responsiveness: the smallest change in a score associated with a clinically important change to the patient. This study sought to summarize the literature on minimal clinically important difference for the most commonly reported shoulder outcome scales.
A literature search of PubMed and EMBASE databases identified 193 citations, 27 of which met the inclusion/exclusion criteria.
For rotator cuff tears, a minimal clinically important difference range of 9-26.9 was reported for American Shoulder and Elbow Surgeons, 8 or 10 for Constant, and 282.6-588.7 for the Western Ontario Rotator Cuff Index. For patients who underwent arthroplasty, a minimal clinically important difference range of 6.3-20.9 was reported for American Shoulder and Elbow Surgeons, 5.7-9.4 for Constant, and 14.1-20.6 for the Shoulder Pain and Disability Index. For proximal humeral fractures, a minimal clinically important difference range of 5.4-11.6 was reported for Constant and 8.1-13.0 for Disability of the Arm, Shoulder, and Hand.
A wide range of minimal clinically important difference values was reported for each patient population and instrument. In the future, a uniform outcome instrument and minimal clinically important difference will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.
患者报告的结果量表可确定治疗反应。这些量表的最小临床重要差异是反应性的衡量标准：与患者临床重要变化相关的评分最小变化。本研究旨在总结最常报告的肩部结果量表的最小临床重要差异文献。
对 PubMed 和 EMBASE 数据库进行文献检索，共确定了 193 条引文，其中 27 条符合纳入/排除标准。
对于肩袖撕裂，美国肩肘外科医师协会（American Shoulder and Elbow Surgeons）报告的最小临床重要差异范围为 9-26.9，常数（Constant）为 8 或 10，西部安大略省肩袖指数（Western Ontario Rotator Cuff Index）为 282.6-588.7。对于接受关节置换术的患者，美国肩肘外科医师协会（American Shoulder and Elbow Surgeons）报告的最小临床重要差异范围为 6.3-20.9，常数（Constant）为 5.7-9.4，肩痛和残疾指数（Shoulder Pain and Disability Index）为 14.1-20.6。对于肱骨近端骨折，常数（Constant）报告的最小临床重要差异范围为 5.4-11.6，手臂、肩部和手部残疾（Disability of the Arm, Shoulder, and Hand）为 8.1-13.0。
每个患者人群和仪器的最小临床重要差异值范围都很广。未来，统一的结果仪器和最小临床重要差异将有助于衡量实践和肩部诊断范围内的临床有意义的变化。
