Minimal Clinically Important Difference of Liverpool Elbow Score in Elbow Arthroplasty

Vishwanathan, Karthik and Alizadehkhaiyat, Omid and Kemp, Graham J. and Frostick, Simon P. (2017) Minimal Clinically Important Difference of Liverpool Elbow Score in Elbow Arthroplasty. Journal of Shoulder and Elbow Surgery Open Access. ISSN 2468-6026

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Abstract

Background
The minimal clinically important difference (MCID) that allows the interpretation of small but meaningful changes following intervention has not been reported for the Liverpool Elbow Score (LES). This study aimed to determine the MCID for the LES in patients undergoing total elbow replacement (TER).

Methods
This observational study is based on preoperative and 1-year postoperative clinical outcome of TER (Discovery Elbow System) in 71 patients using the LES. A four-point Likert-like transition scale was used to evaluate patient satisfaction following TER. A combination of distribution-based (standard deviation of change in the LES; standard error of mean [SEM], smallest detectable change [SDC]) and anchor-based methods (receiver operating curve [ROC]; difference of mean of change in LES) was used to determine range of MCID values.

Results
The mean change in the LES value was 2.4 (SD: 2.1). The estimated SDC value with upper limit of 90% confidence interval was 1.5. The mean change in LES of “satisfied” and “somewhat satisfied” patient groups was 2.4 (SD = 2.1) and 1.1 (SD = 1.4) respectively and the difference between the both means (MCID based on difference of mean in two sub-groups) was 1.3. According to ROC analysis, the value of MCID was 1.6.

Conclusion
The MCID value for the LES was estimated to range between 0.7 and 1.8. The estimated SDC value was 1.5. We propose that the “true” MCID value of LES would be between 1.6 and 1.8 to ensure that the value is higher than the measurement error of LES.

Keywords: Elbow; Total Arthroplasty; Discovery Elbow; Clinical Outcome; Joint Replacement, Elbow Prostheses; Minimal Clinically Important Changes.

Level of Evidence: Therapeutic II

Item Type:	Article
Additional Information and Comments:	NOTICE: this is the author’s version of a work that was accepted for publication in the Journal of Shoulder and Elbow Surgery Open Access. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in the Journal of Shoulder and Elbow Surgery Open Access, August 2017, https://doi.org/10.1016/j.jses.2017.07.004
Keywords:	Elbow; Total Arthroplasty; Discovery Elbow; Clinical Outcome; Joint Replacement, Elbow Prostheses; Minimal Clinically Important Changes.
Faculty / Department:	Faculty of Human and Digital Sciences > School of Health and Sport Sciences
Depositing User:	Omid Khaiyat
Date Deposited:	26 Oct 2017 08:53
Last Modified:	26 Oct 2017 08:56
URI:	https://hira.hope.ac.uk/id/eprint/2220

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