The Minimal Clinically Important Difference of the Michigan Hand Outcomes Questionnaire
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA. The Journal of hand surgery
(Impact Factor: 1.67).
03/2009; 34(3):509-14. DOI: 10.1016/j.jhsa.2008.11.001
To determine the change in score required in various domains of the Michigan Hand Outcomes Questionnaire (MHQ) to indicate meaningful patient improvement, or the minimal clinically important difference (MCID), for 3 common hand conditions: rheumatoid arthritis (RA), carpal tunnel syndrome (CTS) and distal radius fracture (DRF).
The MHQ was administered to patients at 2 time points. Patient satisfaction was defined as a satisfaction score > or =80% of the standard deviation of that patient sample. The minimal change in score in specific MHQ domains that corresponded with patient satisfaction was determined using receiver operating characteristic curves.
For CTS patients, MCIDs of 23, 13, and 8 were identified for the pain, function, and work domains, respectively. For RA patients, pain and function were also identified as having discriminative ability, with MCIDs of 11 and 13, respectively. An MCID of 3 was identified for the activities of daily living domain. For DRF patients, no MHQ domains showed discriminative ability because of the ceiling effect at the 3-month assessment period.
Individual domains of the MHQ can be used to discriminate between patients who are satisfied and those who are not after either carpal tunnel release or silicone arthroplasty of the metacarpophalangeal joints for RA. Pain and function are the domains of the MHQ that are best able to discriminate between patients who are satisfied and those who are not. The identical function MCID for both RA patients and CTS patients, despite markedly different preoperative values, indicates that a standard amount of functional change may indicate patient satisfaction. High postoperative satisfaction, even only 3 months after surgery, prevented any domains from showing discriminative ability for the DRF patients.
Available from: Dariush Nikkhah
- "that were included in the analysis (Figure 1) (Adams et al., 2012; Amirfeyz et al., 2009; Atroshi et al., 2011; Beaton et al., 2001b; Beaton et al., 2011; Beaudreuil et al., 2011; Bessette et al., 1998; Dawson et al., 2008; Franchignoni et al., 2014; Gummesson et al., 2003; Katz et al., 1994; Kim and Jeon, 2013; Kim and Park, 2013; Levine et al., 1993; London et al., 2014; Malay and Chung, 2013; Mintken et al., 2009; Ozer et al., 2013; Ozyurekoglu et al., 2006; Polson et al., 2010; Poltawski and Watson, 2011; Schmitt and Di Fabio, 2004; Shauver and Chung, 2009; Sorensen et al., 2013; Spies-Dorgelo et al., 2006; Tashjian et al., 2009; van der Giesen et al., 2008; Waljee and Chung, 2012; Witthaut et al., 2011). During the manual search, one other MID estimation was identified in a reference from a review article (Carswell et al., 2004). "
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ABSTRACT: Outcomes research in hand surgery provides patients and providers with objective, reliable information to assist in making medical decisions. Endpoint measures in outcomes research and the instruments used to evaluate these endpoints are often specific to a particular disease or region. Hand surgery has many different measurable outcomes that can be used to monitor the quality of surgical practice, inform practice guidelines, and aid in the appropriate allocation of healthcare resources. In this article, we review some research techniques available to study the following surgical outcomes of the hand: national trends in surgical care, surgical complications, objective measures of hand function, patient-reported measures of hand function, and economic burden.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: Prospective cohort.
Patient satisfaction is increasingly used as a metric of health care outcomes. The relationship between patient satisfaction and functional outcomes metrics is understudied.
To determine the minimum recovery needed in grip strength, key pinch strength, and arc of motion needed for patient satisfaction after treatment of distal radius fracture (DRF) with volar locking plating system placement.
A prospective cohort of 125 DRF patients was evaluated three months after surgery for grip strength, key pinch strength, wrist arc of motion, and satisfaction with hand strength and wrist arc of motion. Receiver operating characteristic curves were constructed using patient satisfaction items as the "gold standard" and each functional measure of outcome as a predictor.
We found that the optimal cutpoints to distinguish satisfaction from dissatisfaction occurred when patients had recovered 65% of their grip strength, 87% of their key grip strength, and 95% of the wrist arc of motion, as measured as percents of their uninjured wrists.
A much greater wrist range of motion must be recovered for patients to be satisfied than what is needed to perform activities of daily living.
Diagnosis level 2.
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