title: Minimal important changes in the Constant-Murley score in patients with subacromial pain.
abstract: OBJECTIVE
  The purpose of this study was to determine the minimal important change (MIC) of improvement in the Constant-Murley score in patients with long-standing subacromial pain and in subgroups of patients with subacromial pain with and without rotator cuff ruptures.
  
  
  METHODS
  The MIC was estimated by the anchor-based MIC distribution method, which integrates an anchor- and distribution-based approach: the optimal cutoff point of the receiver operating characteristic curve (MICROC) and the 95% limit cutoff point (MIC95% limit). The study population consisted of 93 patients included in a randomized clinical trial evaluating the effect of a specific exercise strategy.
  
  
  RESULTS
  The MICROC was found at a mean change of 17 points in the Constant-Murley score, which corresponds to a sensitivity of 91% and a specificity of 79%. The MIC95% limit was found at a mean change of 24 points. In the subgroup analysis, the MICROC was found at a mean change of 19 points and the MIC95% limit at 18 points in patients with an intact rotator cuff. In patients with rotator cuff ruptures, the MICROC was found at a mean change of 15 points and the MIC95% limit at 30 points.
  
  
  CONCLUSIONS
  The Constant-Murley score is able to detect the MIC in individual patients with long-standing subacromial pain when the rotator cuff is intact. The estimated MIC values could be used as an indication for relevant changes in the Constant-Murley score in clinical practice and guide the clinician in how to interpret the results of specific treatments.
authors.affiliation: Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden. Electronic address: theresa.holmgren@liu.se.
authors.forename: Theresa
authors.initials: T
authors.lastname: Holmgren
authors.affiliation: Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Oberg
authors.affiliation: Department of Orthopedics, University Hospital of Linköping; Department of Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Adolfsson
authors.affiliation: Department of Orthopedics, University Hospital of Linköping; Department of Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Björnsson Hallgren
authors.affiliation: Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
authors.forename: Kajsa
authors.initials: K
authors.lastname: Johansson
mesh_terms: D000328:Adult; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint; D013708:Tendon Injuries / Q000175:diagnosis*
keywords: Constant-Murley score; Subacromial pain; anchor-based methods; clinical important change; distribution-based methods; minimal important change