Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state associated with upper extremity patient-reported outcome measurement information system scores following the Latarjet procedure

TL;DR

This study identifies thresholds for meaningful improvement in shoulder function and pain after a specific orthopedic surgery using PROMIS scores.

Contribution

The paper establishes MCID, SCB, and PASS values for PROMIS scores following the Latarjet procedure for the first time.

Findings

MCID values for P-UE, P-Interference, and P-Intensity were 3.2, -6.3, and -9.4 respectively.

Generalized joint laxity and history of recurrent dislocations were linked to lower odds of achieving improvement thresholds.

Abstract

The Patient-Reported Outcome Measurement Information System (PROMIS) has been widely used to assess clinical improvement in orthopedic procedures, providing a standardized and responsive measure of function and pain. While PROMIS has been effective in evaluating recovery in upper extremity surgery, specific thresholds for meaningful improvement following the Latarjet procedure (LP) have not been established. The purpose of this study was to determine the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) of PROMIS Upper Extremity (P-UE) Computer Adaptive Testing v2.0, Pain Interference (P-Interference), and Pain Intensity (P-Intensity) scores in patients undergoing the LP for shoulder instability. We hypothesize that PROMIS instruments will effectively distinguish these thresholds for clinically significant improvement with respect to shoulder function and pain following LP.

MCID, SCB, and PASS were calculated using an anchor-based approach at a minimum follow-up of 1 year. The optimal cutoff values for change in PROMIS scores were determined via receiver operating characteristic curves and area under the curve analysis. Regression analysis was conducted to identify patient factors associated with achievement of the MCID, SCB, and PASS thresholds.

A total of 72 patients were included in our analysis. MCID for P-UE, P-Interference, and P-Intensity was determined to be 3.2, −6.3, and −9.4, respectively. Respective SCB values were determined to be 8.1, −10.7, and −11.4. Respective PASS values were determined to be 42.6, 56.7, and 39.4. Corresponding effect size and standardized response means were: P-UE (1.6, 3.4), P-Interference (1.4, 1.2), and P-Intensity (1.7, 1.2). For P-UE, generalized joint laxity was associated with lower odds of achieving SCB. For P-Interference, history of recurrent dislocations was linked to lower odds of achieving MCID. For P-Intensity, generalized joint laxity and history of recurrent dislocations were associated with lower odds of achieving MCID and SCB. Larger Hill-Sachs lesion depth was associated with lower odds of achieving P-intensity PASS.

This study establishes MCID, SCB, and PASS values for PROMIS instruments following LP. Knowledge of these thresholds and patient factors associated with achieving them provide surgeons useful tools for predicting and measuring clinically meaningful outcomes following surgery.

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