Garcia AN, Thigpen CA, Lake AD, Martinez C, Myers H, Cook C. Do older adults with shoulder disorders who meet the minimal clinically important difference also present low disability at discharge? An observational study.
Braz J Phys Ther 2019;
24:152-160. [PMID:
30885628 DOI:
10.1016/j.bjpt.2019.02.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND
The choice of outcome success thresholds may influence clinical management, pay-for-performance, and assessment of value-based care.
OBJECTIVE
To evaluate outcomes success thresholds in older adults using two different methods: 1) Minimal clinically important differences (MCIDs) of the Quick-DASH and 2) Dichotomization of the Quick-DASH based on low disability rating at discharge DESIGN: An observational design (retrospective database study).
SETTING
Dataset of 1109 patients with shoulder disorders.
PARTICIPANTS
297 older adults patients who were diagnosed with rotator cuff related shoulder disorders and were managed through physical therapy treatment.
MAIN OUTCOME MEASURES
We categorized and calculated how many patients met 8.0 and 16.0 point changes on the Quick-DASH. To evaluate outcomes success thresholds using dichotomization, patients who discharge score of ≤20 on the Quick-DASH were considered positive responders with successful outcomes.
RESULTS
The percentage of positive responders who met the MCID thresholds for the Quick-DASH were 63.3% using MCID of 8.0 points, 39.7% using the MCID of 16.0 points, and 46.12% who met discharge score of ≤ 20 on the Quick-DASH. 39.0% met both MCID of 8.0 points and discharge score of ≤ 20 on the Quick-DASH. Only 28% met both MCID of 16.0 points and discharge score of = 20 on the Quick-DASH.
CONCLUSION
Three different success threshold derivations classified patients into three very different assessments of success. Quick-DASH scores of ≤ 20 represent low levels of self-report disability at discharge and can be a stable clinical option for a measure of success to capture whether a treatment results in meaningful improvement.
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