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Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses

A Systematic Review

Dabija, Dominique I., MS1; Jain, Nitin B., MD, MSPH2,3

American Journal of Physical Medicine & Rehabilitation: February 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001169
Research Article: PDF Only

Objective Patient-reported outcome scales determine response to treatment. The minimal clinically important difference (MCID) of these scales is a measure of responsiveness: the smallest change in a score associated with a clinically important change to the patient. This study sought to summarize the literature on MCID for the most commonly reported shoulder outcome scales.

Design A literature search of PubMed and EMBASE databases identified 193 citations, twenty-seven of which met the inclusion/exclusion criteria.

Results For rotator cuff tears, a MCID range of 9-26.9 was reported for American Shoulder and Elbow Surgeons (ASES), 8 or 10 for Constant, and 282.6-588.7 for the Western Ontario Rotator Cuff Index (WORC). For patients who underwent arthroplasty, a MCID range of 6.3-20.9 was reported for ASES, 5.7-9.4 for Constant, and 14.1-20.6 for the Shoulder Pain and Disability Index (SPADI). For proximal humeral fractures, a MCID range of 5.4-11.6 was reported for Constant and 8.1-13.0 for Disability of the Arm, Shoulder, and Hand (DASH).

Conclusion A wide range of MCID values was reported for each patient population and instrument. In the future, a uniform outcome instrument and MCID will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.

1Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA

2Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA

3Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA

Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email:

Source of Funding: Dr. Jain is/was supported by funding from NIAMS 1K23AR059199 and 1U34AR069201.

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