Meaningful changes for the Oxford hip and knee scores after joint replacement surgery
David J Beard, Kristina Harris, Jill Dawson, Helen Doll, David W Murray, Andrew J Carr, Andrew J Price, David J Beard, Kristina Harris, Jill Dawson, Helen Doll, David W Murray, Andrew J Carr, Andrew J Price
Abstract
Objectives: To present estimates of clinically meaningful or minimal important changes for the Oxford Hip Score (OHS) and the Oxford Knee Score (OKS) after joint replacement surgery.
Study design and setting: Secondary data analysis of the NHS patient-reported outcome measures data set that included 82,415 patients listed for hip replacement surgery and 94,015 patients listed for knee replacement surgery was performed.
Results: Anchor-based methods revealed that meaningful change indices at the group level [minimal important change (MIC)], for example in cohort studies, were ∼ 11 points for the OHS and ∼ 9 points for the OKS. For assessment of individual patients, receiver operating characteristic analysis produced MICs of 8 and 7 points for OHS and OKS, respectively. Additionally, the between group minimal important difference (MID), which allows the estimation of a clinically relevant difference in change scores from baseline when comparing two groups, that is, for clinical trials, was estimated to be ∼ 5 points for both the OKS and the OHS. The distribution-based minimal detectable change (MDC90) estimates for the OKS and OHS were 4 and 5 points, respectively.
Conclusion: This study has produced and discussed estimates of minimal important change/difference for the OKS/OHS. These estimates should be used in the power calculations and the interpretation of studies using the OKS and OHS. The MDC90 (∼ 4 points OKS and ∼ 5 points OHS) represents the smallest possible detectable change for each of these instruments, thus indicating that any lower value would fall within measurement error.
Keywords: Hip replacement; Knee replacement; Minimal important change; Minimal important difference; Responder definition; Study designs.
Copyright © 2015 University of Oxford. Published by Elsevier Inc. All rights reserved.
Figures
References
- Mokkink L.B., Terwee C.B., Patrick D.L., Alonso J., Stratford P.W., Knol D.L. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–745.
- Dawson J., Boller I., Doll H., Lavis G., Sharp R., Cooke P. Minimally important change was estimated for the Manchester–Oxford Foot Questionnaire after foot/ankle surgery. J Clin Epidemiol. 2014;67:697–705.
- Crosby R.D., Kolotkin R.L., Williams G.R. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003;56:395–407.
- Lydick E., Epstein R. Interpretation of quality of life changes. Qual Life Res. 1993;2:221–226.
- NHS Information Centre. HES Online. 2012. Available at . Accessed August 13, 2013.
- Murray D., Fitzpatrick R., Rogers K., Pandit H., Beard D., Carr A. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007;89(8):1010–1014.
- US Department of Health and Human Services Food and Drug Administration. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims. 2009.
- Deyo R.A., Centor R.M. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chronic Dis. 1986;39(11):897–906.
- Hanley J.A., McNeil B.J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.
- Green B.F. A primer of testing. Am Psychol. 1981;36(10):1001.
- Beckerman H., Roebroeck M., Lankhorst G., Becher J., Bezemer P., Verbeek A. Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res. 2001;10:571–578.
- Browne J.P., van der Meulen J.H., Lewsey J.D., Lamping D.L., Black N. Mathematical coupling may account for the association between baseline severity and minimally important difference values. J Clin Epidemiol. 2010;63:865–874.
- Browne J., Jamieson L., Lewsey J., van der Meulen J., Black N., Cairns J. Patient reported outcome measures (PROMs) in elective surgery. Rep Department Health. 2007:12.
- Revicki D., Hays R.D., Cella D., Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61:102–109.
- King M.T. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11(2):171–184.
- Hutchings A., Frie K.G., Neuburger J., van der Meulen J., Black N. Late response to patient-reported outcome questionnaires after surgery was associated with worse outcome. J Clin Epidemiol. 2012;66
- Cella D., Hahn E.A., Dineen K. Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Qual Life Res. 2002;11:207–221.
- Wyrwich K.W., Tardino V.M. Understanding global transition assessments. Qual Life Res. 2006;15:995–1004.
- Norman G. Hi! How are you? Response shift, implicit theories and differing epistemologies. Qual Life Res. 2003;12:239–249.
- Beaton D.E., Boers M., Wells G.A. Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol. 2002;14(2):109.
Source: PubMed