Basic ScienceThe minimal detectable change of the Constant score in impingement, full-thickness tears, and massive rotator cuff tears
Section snippets
Study design
This is a cross-sectional cohort study in which we analyze baseline (i.e., preoperative) data from 3 different studies on shoulder disease collected between 2003 and 2011.11, 14, 15, 24 Study 1 was a cross-sectional cohort study on the etiologic mechanisms of SIS.11 Study 2 was a randomized controlled trial comparing the treatment effect of all-arthroscopic to mini-open RC repair.24 Study 3 was a consecutive cohort study on tendon transfer surgery for massive RC tears.14, 15 Other than the
Results
The baseline characteristics of each subgroup and total group are presented in Table I. Patients with SIS were younger compared with patients with supraspinatus tears (10 years; 95% CI, 6.5-12.7; P < .001) and massive RC tears (11 years; 95% CI, 7.4-14.2; P < .001). An age difference between supraspinatus and massive RC tear groups was not detected (P = .417). Also, gender (P = .056) and affected side (P = .506) were not different between the subgroups.
The mean Constant score was significantly
Discussion
This is the first study reporting on the MDC of the Constant score in patients with SIS, supraspinatus tear, and massive RC tear.20 The MDC was 23 points on the Constant score in the overall group. The MDC was 17, 18, and 23 points on the Constant score for SIS, supraspinatus tears, and massive RC tears, respectively.
The MDC can be used to interpret outcome effects of treatment measured, next to clinical relevance of statistical effects. When using the MDC, clinicians and researchers should be
Conclusion
The MDC of the Constant score was 17, 18, and 23 for patients with SIS, with a supraspinatus tear, and with a massive RC tear, respectively. We suggest the application of the MDC to interpret treatment effects. Observed changes smaller than the MDC might be a result of measurement error due to reliability and variance in the study population. Therefore, perceived changes that are clinically relevant or statistically significant might not be detectable by the outcome measurement in patients with
Acknowledgments
We thank P.B. de Witte, MD, BSc for data acquisition of the impingement patients.
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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This study was funded by the Dutch Arthritis Association, grant number 2013-1-060.
Ethical Committee approval: The Leiden University Medical Center Institutional Ethics Review Board approved all the conducted studies (P07.123, P07.116, P09.227, and P11.002).