The Variability of MCID, SCB, PASS, and MOI Thresholds for PROMs in the Reverse Total Shoulder Arthroplasty Literature: A Systematic Review

Avanish Yendluri; Ara Alexanian; Alexander C Lee; Michael N Megafu; William N Levine; Bradford O Parsons; John D Kelly 4th; Robert L Parisien; Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group

doi:10.1016/j.jse.2024.03.051

The Variability of MCID, SCB, PASS, and MOI Thresholds for PROMs in the Reverse Total Shoulder Arthroplasty Literature: A Systematic Review

J Shoulder Elbow Surg. 2024 May 14:S1058-2746(24)00350-1. doi: 10.1016/j.jse.2024.03.051. Online ahead of print.

Authors

Avanish Yendluri¹, Ara Alexanian², Alexander C Lee³, Michael N Megafu⁴, William N Levine⁵, Bradford O Parsons⁶, John D Kelly 4th⁷, Robert L Parisien⁶; Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group

Affiliations

¹ Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: avanish.yendluri@icahn.mssm.edu.
² Harbor-UCLA Medical Center, Torrance, CA, USA.
³ Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA.
⁴ A.T. Still University, Kirksville, MO, USA.
⁵ Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
⁶ Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
⁷ Department of Orthopaedic Surgery, Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 38754543
DOI: 10.1016/j.jse.2024.03.051

Abstract

Background: Reverse total shoulder arthroplasty (RTSA) is a common procedure utilized to address degenerative pathologies of the glenohumeral joint and rotator cuff. Increased reliance on patient-reported outcome measures (PROMs) has placed emphasis on the utilization of the minimum clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS), and maximal outcome improvement (MOI) thresholds to assess the clinical efficacy of RTSA. In this study, we systematically reviewed the MCID, SCB, PASS, and MOI thresholds reported for PROMs following RTSA.

Methods: PubMed, Embase, MEDLINE, Cochrane Library, and Google Scholar were queried for articles from Jan. 1, 2000-Aug. 31, 2023 reporting MCID, SCB, PASS, or MOI values for PROMs following RTSA. Patient demographic data, study characteristics, MCID/SCB/PASS/MOI thresholds, and threshold calculation methods were extracted.

Results: 141 articles were screened with 39 ultimately included, comprising 11,984 total patients that underwent RTSA. 34 (87%) studies reported MCID thresholds, 20 (51%) reported SCB, 5 (13%) reported PASS, and 2 (5%) reported MOI. 25/39 (64%) studies referenced a previous study when reporting MCID, SCB, PASS, or MOI values, 11 (28%) used an anchor-based method to calculate threshold values, 1 (3%) used a distribution-based method, and 2 (5%) used both anchor and distribution methods. There were 19 newly calculated MCID (11), SCB (5), PASS (1), and MOI (2) thresholds. For five of the six most utilized PROMs (ASES, SST, Constant, UCLA, SPADI), the range of reported MCID values exceeded 50% of the most common threshold. For three of the six, the range of SCB values exceeded 25% of the most common threshold.

Conclusion: There is substantial variability in the MCID and SCB threshold values reported in the RTSA literature. Standardizing the methodologic calculation and utilization of MCID, SCB, PASS, and MOI thresholds for RTSA may allow for improved assessment of PROMs.

Keywords: MCID; MOI; PASS; Reverse total shoulder arthroplasty; SCB; patient-reported outcome measure.

Publication types

Review