What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis?

Aims This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. Methods A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed. Results The MDC increased substantially based on selected CIs (MDC 80, MDC 90, and MDC 95), ranging from 5.0 to 7.6 points for the MEPI, and from 8.2 degrees to 12.5 degrees for ROM. The MCID of the MEPI were 8.3 points under distribution-based and 12.2 points under anchor-based; distribution- and anchor-based MCID of ROM were 14.1 degrees and 25.0 degrees. The SCB of the MEPI and ROM were 17.3 points and 43.4 degrees, respectively. The proportion of the patients who attained anchor-based MCID for the MEPI and ROM were 74.0% and 94.7%, respectively; furthermore, 64.2% and 86.8% attained SCB. Non-dominant arm (p = 0.022), higher preoperative MEPI rating (p < 0.001), and postoperative visual analogue scale pain score (p < 0.001) were independent predictors of not achieving MCID for the MEPI, while atraumatic causes (p = 0.040) and higher preoperative ROM (p = 0.005) were independent risk factors for ROM. Conclusion In patients undergoing OEA, the MCID for the increased MEPI is 12.2 points and 25 degrees increased ROM. The SCB is 17.3 points and 43.3 degrees, respectively. Future studies using the MEPI and ROM to assess OEA outcomes should report not only statistical significance but also clinical importance.

Automated summary

The study determined the MDC, MCID, and SCB for MEPI and ROM after OEA. Factors affecting the achievement of MCID were identified. The MCID for MEPI distribution-based was 8.3 points, anchored-based was 12.2 points; ROM distribution-based was 14.1 degrees, anchored-based was 25.0 degrees. The SCB for MEPI and ROM were 17.3 points and 43.4 degrees respectively. Factors associated with not achieving MCID for MEPI and ROM were identified.