title: Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome.
abstract: BACKGROUND
  Patient-reported questionnaires have been widely used to predict symptom severity and functional disability in musculoskeletal disease. Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome.
  
  
  OBJECTIVE
  We asked (1) which of Patient-Rated Wrist Evaluation (PRWE), DASH, and other physical measures was more responsive to clinical improvements, and (2) what was the minimal clinically important difference for the PRWE and DASH after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome.
  
  
  METHODS
  All patients who underwent ulnar shortening osteotomy between March 2008 and February 2011 for idiopathic ulnar impaction syndrome were enrolled in this study. All patients completed the PRWE and DASH questionnaires, and all were evaluated for grip strength and wrist ROM, preoperatively and 12 months postoperatively. We compared the effect sizes observed by each of these instruments. Effect size is calculated by dividing the mean change in a score of each instrument during a specified interval by the standard deviation of the baseline score. In addition, patient-perceived overall improvement was used as the anchor to determine the minimal clinically important differences on the PRWE and DASH 12 months after surgery.
  
  
  RESULTS
  The average score of each item except for wrist flexion and supination improved after surgery. The PRWE was more sensitive than the DASH or than physical measurements in detecting clinical changes. The effect sizes and standardized response means of the outcome measures were as follows: PRWE (1.51, 1.64), DASH (1.12, 1.24), grip strength (0.59, 0.68), wrist pronation (0.33, 0.41), and wrist extension (0.28, 0.36). Patient-perceived overall improvement and score changes of the PRWE and DASH correlated significantly. Minimal clinically important differences were 17 points (of a possible 100) for the PRWE and 13.5 for the DASH (also of 100), and minimal detectable changes were 7.7 points for the PRWE and 9.3 points for the DASH.
  
  
  CONCLUSIONS
  Although the PRWE and DASH were highly sensitive to clinical changes, the PRWE was more sensitive in terms of detecting clinical changes after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. A minimal change of 17 PRWE points or 13.5 DASH points was necessary to achieve a benefit that patients perceived as clinically important. The minimal clinically important differences using these instruments were higher than the values produced by measurement errors.
authors: Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, 911-1 Mok-6-dong, Yangcheon-gu, Seoul, 158-710, Korea. kimjk@ewha.ac.kr
authors: Jae Kwang
authors: JK
authors: Kim
authors: Eun Soo
authors: ES
authors: Park
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018771:Arthralgia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D018737:Hand Strength; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects; D010147:Pain Measurement; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013577:Syndrome; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology*; D055815:Young Adult
references: Am J Occup Ther. 1989 Jul;43(7):444-7
references: 2750859
references: J Clin Epidemiol. 2008 Feb;61(2):102-9
references: 18177782
references: Am J Ind Med. 1996 Jun;29(6):602-8
references: 8773720
references: J Hand Surg Am. 2008 Dec;33(10):1783-8
references: 19084178
references: Scand J Plast Reconstr Surg Hand Surg. 2007;41(6):310-4
references: 17952805
references: J Hand Surg Am. 2003 Jan;28(1):88-93
references: 12563643
references: J Hand Surg Am. 1994 Jul;19(4):665-70
references: 7963331
references: J Hand Surg Am. 2011 Dec;36(12):1899-906
references: 22051229
references: Phys Ther. 1996 Oct;76(10):1109-23
references: 8863764
references: J Bone Joint Surg Am. 2011 Dec 7;93(23):2146-53
references: 22159849
references: Eur Spine J. 2003 Feb;12(1):12-20
references: 12592542
references: J Bone Joint Surg Am. 2005 Dec;87(12):2649-2654
references: 16322614
references: Eur Spine J. 2009 Dec;18(12):1898-904
references: 19533179
references: Med Care. 2000 Sep;38(9 Suppl):II84-90
references: 10982093
references: J Hand Surg Am. 1993 Jan;18(1):46-53
references: 8423317
references: J Hand Ther. 1996 Apr-Jun;9(2):178-83
references: 8784681
references: J Hand Surg Br. 1999 Jun;24(3):316-20
references: 10433445
references: Radiographics. 2002 Jan-Feb;22(1):105-21
references: 11796902
references: Qual Life Res. 2008 Dec;17(10):1257-67
references: 18958582
references: J Hand Surg Br. 2005 May;30(2):129-32
references: 15757763
references: Med Care. 1989 Mar;27(3 Suppl):S178-89
references: 2646488
references: Hand Clin. 1991 May;7(2):295-310
references: 1880164
references: J Hand Surg Am. 2007 Jan;32(1):84-90
references: 17218180
references: J Orthop Trauma. 1998 Nov-Dec;12(8):577-86
references: 9840793
references: Ann Plast Surg. 2007 Jun;58(6):636-9
references: 17522486
references: J Clin Epidemiol. 2006 Jan;59(1):45-52
references: 16360560
references: Mayo Clin Proc. 2002 Apr;77(4):371-83
references: 11936935
references: Spine (Phila Pa 1976). 2006 Mar 1;31(5):578-82
references: 16508555
references: Osteoarthritis Cartilage. 2007 Aug;15(8):918-31
references: 17383907
references: J Hand Surg Am. 2003 Mar;28(2):250-4
references: 12671856