Defining Minimal Clinically Important Difference, Patient Acceptable Symptomatic State and Substantial Clinical Benefit for the Visual Analog Scale Pain Score After Arthroscopic Rotator Cuff Repair

Gerald Joseph Zeng; Vikaesh Moorthy; Ying Hao; Denny Tjiauw Tjoen Lie

doi:10.1016/j.jisako.2024.05.003

Defining Minimal Clinically Important Difference, Patient Acceptable Symptomatic State and Substantial Clinical Benefit for the Visual Analog Scale Pain Score After Arthroscopic Rotator Cuff Repair

J ISAKOS. 2024 May 11:S2059-7754(24)00090-7. doi: 10.1016/j.jisako.2024.05.003. Online ahead of print.

Authors

Gerald Joseph Zeng¹, Vikaesh Moorthy², Ying Hao³, Denny Tjiauw Tjoen Lie²

Affiliations

¹ Department Of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608. Electronic address: https://twitter.com/geraldjz.
² Department Of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608.
³ Singhealth Health Services Research Center (HSRC), 20 College Road, The Academia, Discovery Tower, Level 6, Singapore 169856.

PMID: 38740267
DOI: 10.1016/j.jisako.2024.05.003

Abstract

Introduction: Patient satisfaction after arthroscopic rotator cuff repair (RCR) is commonly assessed with patient-reported outcome measures (PROMs), and there is an increased need to establish clinical relevance within these measures. The purpose of this study was to (1) define Minimal Clinically Important Difference (MCID), Patient Acceptable Symptomatic State (PASS) and Substantial Clinical Benefit (SCB) for the visual analog scale (VAS) pain score in patients undergoing arthroscopic RCR, and (2) identify preoperative predictors of achieving each of these threshold values.

Methods: Data from consecutive patients who underwent primary arthroscopic rotator cuff repair study between 2010 and 2016 were prospectively collected. Baseline data and VAS pain scores were collected preoperatively and at 1 year and 2 years postoperatively. MCID, PASS and SCB were determined using an anchor-based approach, with anchor questions assessing postoperative satisfaction and expectation fulfilment. Multivariate logistic regression analysis was also used to identify preoperative predictors for achieving MCID, PASS and SCB.

Results: A total of 286 patients were included in the final analysis, with an average age of 60.2 ± 10.4 and the majority being female (61.2%). The values for VAS pain score identified to represent MCID, PASS, and SCB, respectively at 1-year postoperatively were: 5, 2 and 1. The rates of achieving clinically significant improvement based on VAS were 60.5%, 63.3% and 57.2% respectively. A higher preoperative VAS was predictive for achieving MCID (odds ratio [OR], 1.84; P<0.01).

Conclusion: This study identified threshold VAS pain scores of 5, 2 and 1 for achieving MCID, PASS, and SCB, respectively, at 1-year follow-up after arthroscopic rotator cuff repair. A higher preoperative VAS pain score was also identified as a statistically significant predictor of attaining MCID after arthroscopic rotator cuff repair.

Level of evidence: II.

Keywords: arthroscopic rotator cuff repair; prognostic factors; rotator cuff; shoulder function.