Do older adults with shoulder disorders who meet the minimal clinically important difference also present low disability at discharge? An observational study.

Published online

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Garcia, AN; Thigpen, CA; Lake, AD; Martinez, C; Myers, H; Cook, C

Published Date

  • February 27, 2019

Published In

PubMed ID

  • 30885628

Pubmed Central ID

  • 30885628

Electronic International Standard Serial Number (EISSN)

  • 1809-9246

Digital Object Identifier (DOI)

  • 10.1016/j.bjpt.2019.02.003

Language

  • eng

Conference Location

  • Brazil