Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb
Abstract Background The Numerical Rating Scale (NRS) and Patient-rated wrist/hand evaluation (PRWHE) are patient-reported outcomes frequently used for evaluating pain and function of the wrist and hand. The aim of this study was to determine thresholds for minimal important difference (MID) and pati...
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BMC
2022-04-01
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Online Access: | https://doi.org/10.1186/s12874-022-01600-1 |
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author | Susanna Stjernberg-Salmela Teemu Karjalainen Joona Juurakko Pirjo Toivonen Eero Waris Simo Taimela Clare L. Ardern Teppo L. N. Järvinen Jarkko Jokihaara |
author_facet | Susanna Stjernberg-Salmela Teemu Karjalainen Joona Juurakko Pirjo Toivonen Eero Waris Simo Taimela Clare L. Ardern Teppo L. N. Järvinen Jarkko Jokihaara |
author_sort | Susanna Stjernberg-Salmela |
collection | DOAJ |
description | Abstract Background The Numerical Rating Scale (NRS) and Patient-rated wrist/hand evaluation (PRWHE) are patient-reported outcomes frequently used for evaluating pain and function of the wrist and hand. The aim of this study was to determine thresholds for minimal important difference (MID) and patient acceptable symptom state (PASS) for NRS pain and PRWHE instruments in patients with base of thumb osteoarthritis. Methods Fifty-two patients with symptomatic base of thumb osteoarthritis wore a splint for six weeks before undergoing trapeziectomy. NRS pain (0 to 10) and PRWHE (0 to 100) were collected at the time of recruitment (baseline), after splint immobilization prior to surgery, and at 3, 6, 9 and 12 months after surgery. Four anchor-based methods were used to determine MID for NRS pain and PRWHE: the receiver operating characteristics (ROC) curve, the mean difference of change (MDC), the mean change (MC) and the predictive modelling methods. Two approaches were used to determine PASS for NRS pain and PRWHE: the 75th percentile and the ROC curve methods. The anchor question for MID was the change perceived by the patient compared with baseline; the anchor question for PASS was whether the patient would be satisfied if the condition were to stay similar. The correlation between the transition anchor at baseline and the outcome at all time points combined was calculated using the Spearman’s rho analysis. Results The MID for NRS pain was 2.5 using the ROC curve method, 2.0 using the MDC method, 2.8 using the MC method, and 2.5 using the predictive modelling method. The corresponding MIDs for PRWHE were 22, 24, 10, and 20. The PASS values for NRS pain and PRWHE were 2.5 and 30 using the ROC curve method, and 2.0 and 22 using the 75th percentile method, respectively. The area under curve (AUC) analyses showed excellent discrimination for all measures. Conclusion We found credible MID estimates for NRS and PRWHE (including its subscales), although the MID estimates varied depending on the method used. The estimates were 20-30% of the range of scores of the instruments. The cut-offs for MID and PASS showed good or excellent discrimination, lending support for their use in future studies. Trial registration This clinimetrics study was approved by the Helsinki University ethical review board (HUS1525/2017). |
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spelling | doaj.art-d83a731193864ca0aa60d60b894d36d32022-12-22T02:35:39ZengBMCBMC Medical Research Methodology1471-22882022-04-012211810.1186/s12874-022-01600-1Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumbSusanna Stjernberg-Salmela0Teemu Karjalainen1Joona Juurakko2Pirjo Toivonen3Eero Waris4Simo Taimela5Clare L. Ardern6Teppo L. N. Järvinen7Jarkko Jokihaara8Department of Hand Surgery, University of Helsinki and Helsinki University HospitalFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalCentral Finland Health Care DistrictFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalDepartment of Hand Surgery, University of Helsinki and Helsinki University HospitalFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalFinnish Centre of Evidence-Based Orthopedics (FICEBO), University of Helsinki and Helsinki University HospitalAbstract Background The Numerical Rating Scale (NRS) and Patient-rated wrist/hand evaluation (PRWHE) are patient-reported outcomes frequently used for evaluating pain and function of the wrist and hand. The aim of this study was to determine thresholds for minimal important difference (MID) and patient acceptable symptom state (PASS) for NRS pain and PRWHE instruments in patients with base of thumb osteoarthritis. Methods Fifty-two patients with symptomatic base of thumb osteoarthritis wore a splint for six weeks before undergoing trapeziectomy. NRS pain (0 to 10) and PRWHE (0 to 100) were collected at the time of recruitment (baseline), after splint immobilization prior to surgery, and at 3, 6, 9 and 12 months after surgery. Four anchor-based methods were used to determine MID for NRS pain and PRWHE: the receiver operating characteristics (ROC) curve, the mean difference of change (MDC), the mean change (MC) and the predictive modelling methods. Two approaches were used to determine PASS for NRS pain and PRWHE: the 75th percentile and the ROC curve methods. The anchor question for MID was the change perceived by the patient compared with baseline; the anchor question for PASS was whether the patient would be satisfied if the condition were to stay similar. The correlation between the transition anchor at baseline and the outcome at all time points combined was calculated using the Spearman’s rho analysis. Results The MID for NRS pain was 2.5 using the ROC curve method, 2.0 using the MDC method, 2.8 using the MC method, and 2.5 using the predictive modelling method. The corresponding MIDs for PRWHE were 22, 24, 10, and 20. The PASS values for NRS pain and PRWHE were 2.5 and 30 using the ROC curve method, and 2.0 and 22 using the 75th percentile method, respectively. The area under curve (AUC) analyses showed excellent discrimination for all measures. Conclusion We found credible MID estimates for NRS and PRWHE (including its subscales), although the MID estimates varied depending on the method used. The estimates were 20-30% of the range of scores of the instruments. The cut-offs for MID and PASS showed good or excellent discrimination, lending support for their use in future studies. Trial registration This clinimetrics study was approved by the Helsinki University ethical review board (HUS1525/2017).https://doi.org/10.1186/s12874-022-01600-1Minimal important differencePatient acceptable symptom statePatient reported outcome measuresTreatment outcomeOsteoarthritisWrist |
spellingShingle | Susanna Stjernberg-Salmela Teemu Karjalainen Joona Juurakko Pirjo Toivonen Eero Waris Simo Taimela Clare L. Ardern Teppo L. N. Järvinen Jarkko Jokihaara Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb BMC Medical Research Methodology Minimal important difference Patient acceptable symptom state Patient reported outcome measures Treatment outcome Osteoarthritis Wrist |
title | Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb |
title_full | Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb |
title_fullStr | Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb |
title_full_unstemmed | Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb |
title_short | Minimal important difference and patient acceptable symptom state for the Numerical Rating Scale (NRS) for pain and the Patient-Rated Wrist/Hand Evaluation (PRWHE) for patients with osteoarthritis at the base of thumb |
title_sort | minimal important difference and patient acceptable symptom state for the numerical rating scale nrs for pain and the patient rated wrist hand evaluation prwhe for patients with osteoarthritis at the base of thumb |
topic | Minimal important difference Patient acceptable symptom state Patient reported outcome measures Treatment outcome Osteoarthritis Wrist |
url | https://doi.org/10.1186/s12874-022-01600-1 |
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