Elsevier

Journal of Shoulder and Elbow Surgery

Volume 18, Issue 6, November–December 2009, Pages 927-932
Journal of Shoulder and Elbow Surgery

Outcomes Analysis
Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease

https://doi.org/10.1016/j.jse.2009.03.021Get rights and content

Background

The MCID is the smallest difference in an outcome score which a patient perceives as beneficial. The PASS is the score below which patients consider themselves well. The purpose of this study was to determine the MCID and PASS for a visual analog scale (VAS) measuring pain in patients treated for rotator cuff disease.

Material and methods

81 patients with rotator cuff disease were evaluated after 6 weeks of non-operative treatment with a VAS measuring pain and two transition questions utilized in determining the MCID and PASS.

Results

The MCID and PASS were estimated to be 1.4 cm (P = .0255) and 3 cm (95% CI – 22.69, 37.31) on a 10 cm VAS measuring pain, respectively. Age (P = .0492) and hand-dominance (P = .0325) affected the MCID while age (P = .0376) and duration of follow-up (P = .0131) affected the PASS.

Discussion

The MCID and PASS estimates provide the basis to determine if statistically significant changes in VAS pain scores after treatment are clinically important and if the treatment allowed patients to achieve a satisfactory state.

Level of evidence

Level 3; Nonconsecutive series of patients, diagnostic study.

Section snippets

Materials and methods

Eighty-one patients with a diagnosis of rotator cuff disease were prospectively enrolled from the clinical practice of 2 physicians specializing in the treatment of shoulder disorders (R.Z.T. and A.P.P.). Prior to enrollment, all patients were initially evaluated with a history, physical examination, and shoulder radiographs. Some patients had a shoulder MRI performed prior to the initial evaluation. All patients who had a concern for a rotator cuff tear based upon history and physical exam

Statistical analysis

The change in VAS pain scores from baseline to follow-up for each patient was calculated. MCIDs were determined utilizing an anchor-based technique described by Tubach et al.13 Patients were classified based upon their response to a question regarding the improvement in pain after treatment (Table II). We classified patients who answered “None- no good at all, ineffective treatment; Poor – some effect but unsatisfactory” on the 4-item question as “unchanged”, and we considered patients who

Results

All patients were determined to have a diagnosis of rotator cuff disease. Rotator cuff tearing was diagnosed by MRI in 14 patients, although not all patients in the study had MRIs performed; therefore, some patients may have had unrecognized tears. There were 39 male and 42 female patients. The dominant shoulder was affected in 67% of patients. The average age of the cohort of patients was 51 years (range, 19-88).

The MCID was determined for the visual analog scale for pain utilizing the 4-item

Discussion

Visual analog pain scales are frequently utilized to evaluate the functional outcome of patients undergoing treatment for rotator cuff disease. We have determined that patients who have a 1.4-cm improvement on a 10-cm visual analog pain scale have undergone a minimal clinically important change. Older patients and nondominant shoulders required a larger change in order to obtain a clinically important difference compared to younger patients and dominant injured shoulders. We also determined

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The University of Utah Hospital and Clinics Investigational Review Board approved this study. Application #00023136.

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