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Research ArticleArticle

Examining the Minimal Important Difference of Patient-reported Outcome Measures for Individuals with Knee Osteoarthritis: A Model Using the Knee Injury and Osteoarthritis Outcome Score

Kathryn A.G. Mills, Justine M. Naylor, Jillian P. Eyles, Ewa M. Roos and David J. Hunter
The Journal of Rheumatology February 2016, 43 (2) 395-404; DOI: https://doi.org/10.3899/jrheum.150398
Kathryn A.G. Mills
From the Centre for Physical Health, Department of Medicine and Health Sciences, Macquarie University; Orthopaedic Department, Liverpool Hospital; South West Sydney Clinical School, University of New South Wales; Ingham Institute of Applied Medical Research; Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia; Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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  • For correspondence: Kathryn.mills@mq.edu.au
Justine M. Naylor
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Jillian P. Eyles
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Ewa M. Roos
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David J. Hunter
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Abstract

Objective. To examine the influence of different analytical methods, baseline covariates, followup periods, and anchor questions when establishing a minimal important difference (MID) for individuals with knee osteoarthritis (OA). Second, to propose MID for improving and worsening on the Knee injury and Osteoarthritis Outcome Score (KOOS).

Methods. Retrospective analysis of prospectively collected data from 272 patients with knee OA undergoing a multidisciplinary nonsurgical management strategy. The magnitude and rate of change as well as the influence of baseline covariates were examined for 5 KOOS subscales over 52 weeks. The MID for improving and worsening were investigated using 4 anchor-based methods.

Results. Waitlisted for joint replacement and exhibiting unilateral/bilateral symptoms influenced change in KOOS over time. Generally, low correlations between anchors and KOOS change scores limited calculations of MID; thus, they were only proposed for the pain, activities of daily living, and quality of life subscales. The method used to calculate the MID influenced the cutpoint; however, the type of anchor question only influenced the MID when analyzed with a particular mean change method. Depending on patient and clinical characteristics, the subscale, and the analytical approach used, the MID for KOOS improvement ranged from an absolute change of −1.5 to 20.6 points and worsening ranged from −19.17 to 8.5 points.

Conclusion. MID vary with patient and clinical characteristics, KOOS subscale, and analytical approach. Provided the anchor question is relevant to the patient-reported outcome and baseline status is considered, the anchor does not appear to influence the MID for improvement or worsening when using some anchor-based methods.

Key Indexing Terms:
  • KNEE OSTEOARTHRITIS
  • PATIENT OUTCOME ASSESSMENT
  • QUALITY INDICATORS

Footnotes

  • Jillian Eyles receives funding from a Ramsay Health Care Allied Health Scholarship and a Royal North Shore Hospital Staff Specialist Award. Professor Hunter is supported by a National Health and Medical Research Council Practitioner Fellowship.

  • Accepted for publication November 10, 2015.
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The Journal of Rheumatology
Vol. 43, Issue 2
1 Feb 2016
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Examining the Minimal Important Difference of Patient-reported Outcome Measures for Individuals with Knee Osteoarthritis: A Model Using the Knee Injury and Osteoarthritis Outcome Score
Kathryn A.G. Mills, Justine M. Naylor, Jillian P. Eyles, Ewa M. Roos, David J. Hunter
The Journal of Rheumatology Feb 2016, 43 (2) 395-404; DOI: 10.3899/jrheum.150398

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Examining the Minimal Important Difference of Patient-reported Outcome Measures for Individuals with Knee Osteoarthritis: A Model Using the Knee Injury and Osteoarthritis Outcome Score
Kathryn A.G. Mills, Justine M. Naylor, Jillian P. Eyles, Ewa M. Roos, David J. Hunter
The Journal of Rheumatology Feb 2016, 43 (2) 395-404; DOI: 10.3899/jrheum.150398
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Keywords

KNEE OSTEOARTHRITIS
PATIENT OUTCOME ASSESSMENT
QUALITY INDICATORS

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