University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A..
University of Arizona, Department of Orthopaedic Surgery, Tucson, Arizona, U.S.A.
Arthroscopy. 2024 Apr;40(4):1108-1116. doi: 10.1016/j.arthro.2023.08.076. Epub 2023 Sep 15.
To study the prevalence and quality of application of minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient-acceptable symptomatic state (PASS), and maximum outcome improvement (MOI), reported in the orthopaedic sports medicine knee and shoulder literature in recent years and to bring awareness of proper use of such metrics.
A literature review of all shoulder and knee articles published from the American Journal of Sports Medicine (AJSM), Journal of Shoulder and Elbow Surgery (JSES), and Arthroscopy from 2016 to 2020 was performed, specifically investigating whether MCID, SCB, PASS, or MOI were used or reported. Additionally, the way these metrics were reported and interpreted was recorded.
Out of 5,039 studies, 889 shoulder and knee studies met the inclusion criteria. Overall, 16.7% reported either MCID, PASS, or SCB. MCID was the most reported across all 3 journals. MCID was reported 12.4% of the time throughout the 5 years. PASS was reported 3.2% and SCB 1.1% of the time over the 5 years. MOI was not reported by any of the journals during this period. There was a statistically significant increase in MCID reporting in 2 of the 3 journals over the 5-year course, Arthroscopy (P = .02) and AJSM (P = .05). There was no statistically significant increase in PASS or SCB reporting rates in all 3 journals. Only 39.1% of studies reported MCID correctly (i.e., defined as the number of individual patients meeting MCID/total patients in the study).
This study shows an increasing trend in the use of clinically significant outcome metrics, such as MCID, for interpretation of patient-reported outcomes; however, these individual metrics are often not being used on the individual level and subsequently not reported accurately. We recommend determining whether the specific metric met the threshold per individual patient and then reporting those as a percentage of the sample population to achieve the full potential of these metrics and translate them accurately across various studies.
As the usage of clinically significant outcome metrics rises, so does the need for accurate reporting. These findings will encourage future studies to follow a more standardized format.
研究近年来在矫形运动医学膝关节和肩部文献中报道的最小临床重要差异（MCID）、实质性临床获益（SCB）、患者可接受的症状状态（PASS）和最大结局改善（MOI）的应用率和质量，并提高对这些指标正确使用的认识。
对 2016 年至 2020 年期间在《美国运动医学杂志》（AJSM）、《肩肘外科杂志》（JSES）和《关节镜》上发表的所有肩部和膝关节文章进行文献回顾，具体调查是否使用或报告了 MCID、SCB、PASS 或 MOI。此外，还记录了这些指标的报告和解释方式。
在 5039 项研究中，有 889 项肩部和膝关节研究符合纳入标准。总体而言，有 16.7%的研究报告了 MCID、PASS 或 SCB。在所有 3 种期刊中，MCID 的报道最多。在这 5 年中，MCID 的报告率为 12.4%。在这 5 年中，PASS 的报告率为 3.2%，SCB 的报告率为 1.1%。在此期间，没有任何一种期刊报告 MOI。在这 5 年中，3 种期刊中有 2 种（关节镜，P=.02；AJSM，P=.05）的 MCID 报告率呈统计学显著增加。在所有 3 种期刊中，PASS 和 SCB 的报告率均无统计学显著增加。只有 39.1%的研究正确报告了 MCID（即，满足 MCID 的个体患者数/研究中的总患者数）。
本研究显示，用于解释患者报告结局的临床有意义的结局指标（如 MCID）的使用呈上升趋势；然而，这些单项指标通常未在个体水平上使用，因此未准确报告。我们建议确定每个个体患者的具体指标是否达到阈值，然后报告这些指标在样本人群中的百分比，以充分发挥这些指标的潜力，并在不同的研究中准确地转化它们。
随着临床有意义的结局指标的使用增加，准确报告的需求也随之增加。这些发现将鼓励未来的研究遵循更标准化的格式。
