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Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ Rapid Recommendation
  1. Qiukui Hao1,2,
  2. Tahira Devji2,
  3. Dena Zeraatkar2,
  4. Yuting Wang1,2,
  5. Anila Qasim2,
  6. Reed A C Siemieniuk2,
  7. Per Olav Vandvik3,4,
  8. Tuomas Lähdeoja5,6,
  9. Alonso Carrasco-Labra2,
  10. Thomas Agoritsas2,7,
  11. Gordon Guyatt2,8
  1. 1 The Center of Gerontology and Geriatrics/ National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
  2. 2 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3 Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
  4. 4 Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
  5. 5 Finnish Center of Evidence Based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland
  6. 6 Department of Orthopaedics and Traumatology, HUS Helsinki University Hospital, Helsinki, Finland
  7. 7 Division of General Internal Medicine and Division of Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
  8. 8 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Qiukui Hao; haoqiukui{at}


Objectives To identify credible anchor-based minimal important differences (MIDs) for patient-reported outcome measures (PROMs) relevant to a BMJ Rapid Recommendations addressing subacromial decompression surgery for shoulder pain.

Design Systematic review.

Outcome measures Estimates of anchor-based MIDs, and their credibility, for PROMs judged by the parallel BMJ Rapid Recommendations panel as important for informing their recommendation (pain, function and health-related quality of life (HRQoL)).

Data sources MEDLINE, EMBASE and PsycINFO up to August 2018.

Study selection and review methods We included original studies of any intervention for shoulder conditions reporting estimates of anchor-based MIDs for relevant PROMs. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria. Six reviewers, working in pairs, independently extracted data from eligible studies using a predesigned, standardised, pilot-tested extraction form and independently assessed the credibility of included studies using an MID credibility tool.

Results We identified 22 studies involving 5562 patients that reported 74 empirically estimated anchor-based MIDs for 10 candidate instruments to assess shoulder pain, function and HRQoL. We identified MIDs of high credibility for pain and function outcomes and of low credibility for HRQoL. We offered median estimates for the systematic review team who applied these MIDs in Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence summaries and in their interpretations of results in the linked systematic review addressing the effectiveness of surgery for shoulder pain.

Conclusions Our review provides anchor-based MID estimates, as well as a rating of their credibility, for PROMs for patients with shoulder conditions. The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain, and could also prove useful for authors addressing other interventions for shoulder problems.

PROSPERO registration number CRD42018106531.

  • minimal important differences
  • shoulder condition
  • patient-reported outcome measures

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  • Patient consent for publication Not required.

  • Contributors GG and RACS conceived the study idea; QH designed the search strategy; QH, YW and DZ screened studies for eligibility; QH, TD, YW, DZ, RACS and AQ extracted data and assessed the credibility; QH wrote the first draft of the manuscript; GG, TD, POV, TL, TA, ACL and RACS interpreted the data analysis and critically revised the manuscript. QH is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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