Restricted accessResearch articleFirst published online 2023-10
Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger
We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger.
AbdoliAHashemizadeh AghdaSMJalil AbrishamSM.Comparing the corticosteroid injection and A1 pulley percutaneous release in treatment of trigger finger: a clinical trial. J Hand Surg Asian Pac. 2021,
26: 207–13.
2.
AkhtarSBradleyMJQuintonDNBurkeFD.Management and referral for trigger finger/thumb. BMJ. 2005,
331: 30–3.
3.
AtthakomolPManosroiWSanguanrungsirikulS, et al.
A Thai version of the Michigan Hand Questionnaire (Thai MHQ): an investigation of the psychometric properties. Health Qual Life Outcomes. 2020,
18: 313.
4.
CalfeeRPAdamsAA.Clinical research and patient-rated outcome measures in hand surgery. J Hand Surg Am. 2012,
37: 851–5.
5.
ChungKCPillsburyMSWaltersMRHaywardRA.Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998,
23: 575–87.
6.
CookCE.Clinimetrics corner: the minimal clinically important change score (MICD): a necessary pretense. J Man Manip Ther. 2008,
16: E82–3.
7.
CopayAGSubachBRGlassmanSDPollyDWJrSchulerTC.Understanding the minimum clinically important difference: a review of concepts and methods. Spine J. 2007,
7: 541–6.
8.
DanoffJRGoelRSuttonRMaltenfortMGAustinMS.How much pain is significant? Defining the minimal clinically important difference for the visual analog scale for pain after total joint arthroplasty. J Arthroplasty. 2018,
33: S71–5 e2.
9.
DrijkoningenTvan BerckelMBeckerSJERingDCMudgalCS.Night splinting for idiopathic trigger digits. Hand (NY). 2018,
13: 558–62.
10.
EngelLBeatonDEToumaZ.Minimal clinically important difference: a review of outcome measure score interpretation. Rheum Dis Clin North Am. 2018,
44: 177–88.
11.
GerlingerCSchmelterT.Determining the non-inferiority margin for patient reported outcomes. Pharm Stat. 2011,
10: 410–3.
JaeschkeRSingerJGuyattGH.Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989,
10: 407–15.
14.
KazukiKEgiTOkadaMTakaokaK.Clinical outcome of extrasynovial steroid injection for trigger finger. Hand Surg. 2006,
11: 1–4.
15.
KoopmanJEHundepoolCADurakuLS, et al. Complications and functional outcomes following trigger finger release: A prospective cohort study of 1879 patients. Plast Reconstr Surg. 2022a.
16.
KoopmanJEHundepoolCAWoutersRM, et al.
Factors associated with self-reported pain and hand function following surgical A1 pulley release. J Hand Surg Eur. 2022b,
47: 734–41.
17.
KoopmanJEvan KooijYESellesRW, et al.
Determining the minimally important change of the Michigan Hand Outcomes Questionnaire in patients undergoing trigger finger release. J Hand Ther. 2023,
36: 139–47.
18.
LangerDLuriaSBar-Haim ErezAMichailevichMRogevNMaeirA.Stenosing flexor tenosynovitis: validity of standard assessment tools of daily functioning and quality of life. J Hand Ther. 2015,
28: 384–7; quiz 8.
LiuDHTsaiMWLinSH, et al.
Ultrasound-guided hyaluronic acid injections for trigger finger: a double-blinded, randomized controlled trial. Arch Phys Med Rehabil. 2015,
96: 2120–7.
21.
LiuX.Classification accuracy and cut point selection. Stat Med. 2012,
31: 2676–86.
22.
LondonDAStepanJGCalfeeRP.Determining the Michigan Hand Outcomes Questionnaire minimal clinically important difference by means of three methods. Plast Reconstr Surg. 2014,
133: 616–25.
23.
LuYBeletskyAChahlaJ, et al.
How can we define clinically important improvement in pain scores after biceps tenodesis?J Shoulder Elbow Surg. 2021,
30: 430–8.
24.
LunsfordDValdesKHengyS.Conservative management of trigger finger: a systematic review. J Hand Ther. 2019,
32: 212–21.
MalaySGroupSUNSChungKC.The minimal clinically important difference after simple decompression for ulnar neuropathy at the elbow. J Hand Surg Am. 2013,
38: 652–9.
27.
MartinRLKivlanBRChristoforettiJJ, et al.
Minimal clinically important difference and substantial clinical benefit values for a pain visual analog scale after hip arthroscopy. Arthroscopy. 2019,
35: 2064–9.
28.
MouelhiYJouveECastelliCGentileS.How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020,
18: 136–52.
29.
MurphyDFaillaJMKoniuchMP.Steroid versus placebo injection for trigger finger. J Hand Surg Am. 1995,
20: 628–31.
30.
NormanGRSridharFGGuyattGHWalterSD.Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Med Care. 2001,
39: 1039–47.
31.
PatelMRBassiniL.Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992,
17: 110–3.
32.
QuinnellRC.Conservative management of trigger finger. Practitioner. 1980,
224: 187–90.
33.
RandallDJZhangYLiHHubbardJCKazmersNH.Establishing the minimal clinically important difference and substantial clinical benefit for the pain visual analog scale in a postoperative hand surgery population. J Hand Surg Am. 2022,
47: 645–53.
34.
ReedMDVan NostranW.Assessing pain intensity with the visual analog scale: a plea for uniformity. J Clin Pharmacol. 2014,
54: 241–4.
35.
RevickiDHaysRDCellaDSloanJ.Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008,
61: 102–9.
36.
RingD.Benchmarking changes in symptom intensity and magnitude of disability. J Hand Surg Am. 2013,
38: 650–1.
37.
RingDLozano-CalderonSShinRBastianPMudgalCJupiterJ.A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg Am. 2008,
33: 516–22; discussion 23–4.
38.
Ruiz-MedranoEEspinosa-OrtegaHFArce-SalinasCA.The effect of concomitant hand osteoarthritis on pain and disease activity in patients with rheumatoid arthritis. Clin Rheumatol. 2019,
38: 2709–16.
39.
SedaghatAR.Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures. Otolaryngol Head Neck Surg. 2019,
161: 551–60.
40.
ShapiroLMEpplerSLRoeAKMorrisAKamalRN.The patient perspective on patient-reported outcome measures following elective hand surgery: a convergent mixed-methods analysis. J Hand Surg Am. 2021,
46: 153 e1–e11.
41.
ShauverMJChungKC.The minimal clinically important difference of the Michigan Hand Outcomes questionnaire. J Hand Surg Am. 2009,
34: 509–14.
42.
SheikhEPetersJDSaydeWMaltenfortMLeinberryC.A prospective randomized trial comparing the effectiveness of one versus two (staged) corticosteroid injections for the treatment of stenosing tenosynovitis. Hand (NY). 2014,
9: 340–5.
43.
ShenPCChouSHLuCC, et al.
Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis. Clin Rehabil. 2020,
34: 1217–29.
44.
SmithMVCalfeeRPBaumgartenKMBrophyRHWrightRW.Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am. 2012,
94: 277–85.
45.
SorensenAAHowardDTanWHKetchersidJCalfeeRP.Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013,
38: 641–9.
46.
TarbhaiKHannahSvon SchroederHP.Trigger finger treatment: a comparison of 2 splint designs. J Hand Surg Am. 2012,
37: 243–9, 9 e1.
47.
TashjianRZHungMKeenerJD, et al.
Determining the minimal clinically important difference for the American shoulder and elbow surgeons score, simple shoulder test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. J Shoulder Elbow Surg. 2017,
26: 144–8.
48.
Van der RoerNOsteloRWBekkeringGEvan TulderMWde VetHC.Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine (Phila Pa 1976). 2006,
31: 578–82.
49.
Weinstock-ZlotnickGPageCGhomrawiHMWolffAL.Responsiveness of three patient report outcome (PRO) measures in patients with hand fractures: a preliminary cohort study. J Hand Ther. 2015,
28: 403–10; quiz 11.
50.
WrightAHannonJHegedusEJKavchakAE.Clinimetrics corner: a closer look at the minimal clinically important difference (MCID). J Man Manip Ther. 2012,
20: 160–6.
51.
WyrwichKWBullingerMAaronsonN, et al.
Estimating clinically significant differences in quality of life outcomes. Qual Life Res. 2005,
14: 285–95.
