Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses: A Systematic Review

Objective Patient-reported outcome scales determine response to treatment. The minimal clinically important difference (MCID) 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 MCID for the most commonly reported shoulder outcome scales. Design A literature search of PubMed and EMBASE databases identified 193 citations, twenty-seven of which met the inclusion/exclusion criteria. Results For rotator cuff tears, a MCID range of 9-26.9 was reported for American Shoulder and Elbow Surgeons (ASES), 8 or 10 for Constant, and 282.6-588.7 for the Western Ontario Rotator Cuff Index (WORC). For patients who underwent arthroplasty, a MCID range of 6.3-20.9 was reported for ASES, 5.7-9.4 for Constant, and 14.1-20.6 for the Shoulder Pain and Disability Index (SPADI). For proximal humeral fractures, a MCID range of 5.4-11.6 was reported for Constant and 8.1-13.0 for Disability of the Arm, Shoulder, and Hand (DASH). Conclusion A wide range of MCID values was reported for each patient population and instrument. In the future, a uniform outcome instrument and MCID will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses. Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children's Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email: nitin.jain@vanderbilt.edu Source of Funding: Dr. Jain is/was supported by funding from NIAMS 1K23AR059199 and 1U34AR069201. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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