What Are the Minimally Important Changes of Four Commonly Used Patient-reported Outcome Measures for 36 Hand and Wrist Condition-Treatment Combinations?

Patient-reported outcome measures (PROMs) are frequently used to assess treatment outcomes for hand and wrist conditions. To adequately interpret these outcomes, it is important to determine whether a statistically significant change is also clinically relevant. For this purpose, the minimally important change (MIC) was developed, representing the minimal within-person change in outcome that patients perceive as a beneficial treatment effect. Prior studies demonstrated substantial differences in MICs between condition-treatment combinations, suggesting that MICs are context-specific and cannot be reliably generalized. Hence, a study providing MICs for a wide diversity of condition-treatment combinations for hand and wrist conditions will contribute to more accurate treatment evaluations. (1) What are the MICs of the most frequently used PROMs for common condition-treatment combinations of hand and wrist conditions? (2) Do MICs vary based on the invasiveness of the treatment (nonsurgical treatment or surgical treatment)? This study is based on data from a longitudinally maintained database of patients with hand and wrist conditions treated in one of 26 outpatient clinics in the Netherlands between November 2013 and November 2020. Patients were invited to complete several validated PROMs before treatment and at final follow-up. All patients were invited to complete the VAS for pain and hand function. Depending on the condition, patients were also invited to complete the Michigan Hand outcomes Questionnaire (MHQ) (finger and thumb conditions), the Patient-rated Wrist/Hand Evaluation (PRWHE) (wrist conditions), or the Boston Carpal Tunnel Questionnaire (BCTQ) (nerve conditions). Additionally, patients completed the validated Satisfaction with Treatment Result Questionnaire at final follow-up. Final follow-up timepoints were 3 months for nonsurgical and minor surgical treatment (including trigger finger release) and 12 months for major surgical treatment (such as trapeziectomy). Our database included 55,651 patients, of whom we excluded 1528 who only required diagnostic management, 25,099 patients who did not complete the Satisfaction with Treatment Result Questionnaire, 3509 patients with missing data in the PROM of interest at baseline or follow-up, and 1766 patients who were part of condition-treatment combinations with less than 100 patients. The final sample represented 43% (23,749) of all patients and consisted of 36 condition-treatment combinations. In t