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Comparative responsiveness and minimal change for the Oxford Elbow Score following surgery

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Abstract

Purpose

To assess the responsiveness and minimal change for the Oxford Elbow Score (OES) using anchor- and distribution-based approaches.

Methods

A prospective observational study of 104 patients undergoing elbow surgery at a specialist orthopaedic hospital was carried out. Patients completed the OES and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires (both scored on a 0 to 100 scale) pre- and 6 months post-surgery. Transition items (used as anchors) assessed perceived changes following surgery. Indicators of responsiveness were the effect size; the anchor-based minimal clinically important difference (MCID) and best cut-point on the receiver operator characteristic (ROC) curve; and the distribution-based minimal detectable change (MDC).

Results

The three elbow-specific OES scales (Function, Pain, Social-Psychological) produced generally larger effect sizes (0.79, 1.14 and 1.18, respectively) than the upper-limb-specific DASH scale (0.76). Clear associations were observed between transition items and all OES and DASH scores (all r > |0.35|). The MCIDs for the OES Function scale and the DASH were similar (≈10), but were larger for the OES Pain and Social-Psychological scales (≈18), reflecting their lower (i.e. poorer) baseline scores and larger effect sizes. The MCIDs were, however, only consistently larger than the MDCs for the OES Pain domain. The OES Function scale and the DASH performed similarly on ROC analysis, but with the OES Pain and Social-Psychological scales demonstrating superior efficiency.

Conclusions

For elbow surgery, the 12-item three-scale OES is highly responsive to 6-month post-operative outcomes, with its performance being generally better than that of the 30-item one-scale DASH. Study estimates of minimal change for the OES may be useful for informing sample size calculations and interpreting outcomes in future clinical trials.

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References

  1. Pynsent, P., Fairbank, J. C. T., & Carr, A. (1993). Outcome measures in orthopaedics. Oxford: Butterworth-Heinemann.

    Google Scholar 

  2. Dawson, J., Fitzpatrick, R., Murray, D., & Carr, A. (1996). The problem of ‘noise’ in monitoring patient-based outcomes: generic, disease-specific and site-specific instruments for total hip replacement. Journal of Health Services Research & Policy, 1, 224–231.

    CAS  Google Scholar 

  3. Dawson, J., Fitzpatrick, R., Carr, A., & Murray, D. (1996). Questionnaire on the perceptions of patients about total hip replacement. The Journal of Bone and Joint Surgery. British Volume, 78, 185–190.

    PubMed  CAS  Google Scholar 

  4. Dawson, J., Fitzpatrick, R., Murray, D., & Carr, A. (1998). Questionnaire on the perceptions of patients about total knee replacement. The Journal of Bone and Joint Surgery. British Volume, 80, 63–69. doi:10.1302/0301-620X.80B1.7859.

    Article  PubMed  CAS  Google Scholar 

  5. Dawson, J., Fitzpatrick, R., & Carr, A. (1996). Questionnaire on the perceptions of patients about shoulder surgery. The Journal of Bone and Joint Surgery. British Volume, 78, 593–600.

    PubMed  CAS  Google Scholar 

  6. Dawson, J., Fitzpatrick, R., & Carr, A. (1999). The assessment of shoulder instability. The development and validation of a questionnaire. The Journal of Bone and Joint Surgery. British Volume, 81, 420–426.

    Article  PubMed  CAS  Google Scholar 

  7. Khan, F., Ng, L., Gonzalez, S., Hale, T., & Turner-Stokes, L. (2008). Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database of Systematic Reviews (Online : Update Software), 2:CD004957. Review.

  8. Huber, W., Hofstaetter, J. G., Hanslik-Schnabel, B., Posch, M., & Wurnig, C. (2004). The German version of the Oxford Shoulder Score—cross-cultural adaptation and validation. Archives of Orthopaedic and Trauma Surgery, 124, 531–536. doi:10.1007/s00402-004-0716-z.

    Article  PubMed  Google Scholar 

  9. Canterbury District Health Board (DHB) (2007) New Zealand National Joint Register. Home page at: http://www.cdhb.govt.nz/NJR/. Canterbury DHB, New Zealand.

  10. Hudak, P. L., Amadio, P. C., & Bombardier, C. (1996). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). American Journal of Industrial Medicine 29, 602–608. Published erratum appears in Am J Ind Med 1996 Sep;30(3):372. doi:10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L.

    Article  PubMed  CAS  Google Scholar 

  11. King, G. J. W., Richards, R. R., Zuckerman, J. D., Blasier, R., Dillman, C., Friedman, R. J., et al. (1999). A standardized method for assessment of elbow function. Journal of Shoulder and Elbow Surgery, 8, 351–354. doi:10.1016/S1058-2746(99)90159-3.

    Article  PubMed  CAS  Google Scholar 

  12. Overend, T. J., Wuori-Fearn, J. L., Kramer, J. F., & MacDermid, J. C. (1999). Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis. Journal of Hand Therapy, 12, 31–37.

    PubMed  CAS  Google Scholar 

  13. Sathyamoorthy, P., Kemp, G. J., Rawal, V., Rayner, V., & Frostick, S. P. (2004). Development and validation of an elbow score. Rheumatology (Oxford), 43, 1434–1440. doi:10.1093/rheumatology/keh367.

    Article  CAS  Google Scholar 

  14. Dawson, J., Doll, H., Boller, I., Fitzpatrick, R., Little, C., Rees, J., et al. (2008). The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. The Journal of Bone and Joint Surgery. British Volume, 90, 466–473. doi:10.1302/0301-620X.90B4.20290.

    Article  PubMed  CAS  Google Scholar 

  15. Beaton, D. E. (2000). Understanding the relevance of measured change through studies of responsiveness. Spine, 25, 3192–3199. doi:10.1097/00007632-200012150-00015.

    Article  PubMed  CAS  Google Scholar 

  16. Terwee, C. B., Dekker, F. W., Wiersinga, W. M., Prummel, M. F., & Bossuyt, P. M. M. (2003). On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Quality of Life Research, 12, 349–362. doi:10.1023/A:1023499322593.

    Article  PubMed  CAS  Google Scholar 

  17. Guyatt, G., Walter, S., & Norman, G. (1987). Measuring change over time: assessing the usefulness of evaluative instruments. Journal of Chronic Diseases, 40, 171–178. doi:10.1016/0021-9681(87)90069-5.

    Article  PubMed  CAS  Google Scholar 

  18. Liang, M. H. (2000). Longitudinal construct validity: establishment of clinical meaning in patient evaluative instruments. Medical Care, 38, II84–II90. doi:10.1097/00005650-200009002-00013.

    Article  PubMed  CAS  Google Scholar 

  19. Hays, R. D., & Hadorn, D. (1992). Responsiveness to change: an aspect of validity, not a separate dimension. Quality of Life Research, 1, 73–75. doi:10.1007/BF00435438.

    Article  PubMed  CAS  Google Scholar 

  20. Wyrwich, K. W., Tierney, W. M., & Wolinsky, F. D. (1999). Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. Journal of Clinical Epidemiology, 52, 861–873. doi:10.1016/S0895-4356(99)00071-2.

    Article  PubMed  CAS  Google Scholar 

  21. Jaeschke, R., Singer, J., & Guyatt, G. H. (1989). Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10, 407–415. doi:10.1016/0197-2456(89)90005-6.

    Article  PubMed  CAS  Google Scholar 

  22. Fayers, P. M., & Machin, D. (2000). Quality of life: assessment, analysis and interpretation. Chichester: Wiley.

    Google Scholar 

  23. de Vet, H. C., Terwee, C. B., Ostelo, R. W., Beckerman, H., Knol, D. L., & Bouter, L. M. (2006). Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health and Quality of Life Outcomes, 4, 54. doi:10.1186/1477-7525-4-54.

    Article  PubMed  Google Scholar 

  24. Deyo, R. A., & Centor, R. M. (1986). Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. Journal of Chronic Diseases, 39, 897–906. doi:10.1016/0021-9681(86)90038-X.

    Article  PubMed  CAS  Google Scholar 

  25. Revicki, D., Hays, R. D., Cella, D., & Sloan, J. (2008). Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of Clinical Epidemiology, 61, 102–109. doi:10.1016/j.jclinepi.2007.03.012.

    Article  PubMed  Google Scholar 

  26. SPSS Inc. (2007) SPSS statistical software: release 15.0. Chicago, IL: SPSS Inc.

  27. StataCorp. (2007). Stata statistical software: release 10. College Station, TX: StataCorp.

  28. Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27, S178–S189. doi:10.1097/00005650-198903001-00015.

    Article  PubMed  CAS  Google Scholar 

  29. Cohen, J. (1997). Statistical power analysis for the behavioural sciences. New York: Academic Press.

    Google Scholar 

  30. Hanley, J. A., & McNeil, B. J. (1983). A method of comparing the areas under receiver operating characteristic derived curves from the same cases. Radiology, 148, 839–843.

    PubMed  CAS  Google Scholar 

  31. Riddle, D. L., Stratford, P. W., & Binkley, J. M. (1998). Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part 2. Physical Therapy, 78, 1197–1207.

    PubMed  CAS  Google Scholar 

  32. Stratford, P. W., Binkley, J. M., & Riddle, D. L. (1996). Health status measures: strategies and analytic methods for assessing change scores. Physical Therapy, 76, 1109–1123.

    PubMed  CAS  Google Scholar 

  33. Beaton, D. E., Katz, J. N., Fossel, A. H., Wright, J. G., Tarasuk, V., & Bombardier, C. (2001). Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. Journal of Hand Therapy, 14, 128–146.

    PubMed  CAS  Google Scholar 

  34. Kovacs, F. M., Abraira, V., Royuela, A., Corcoll, J., Alegre, L., Tomás M, et al. (2008). Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskeletal Disorders, 9, 43. doi:10.1186/1471-2474-9-43.

    Article  PubMed  Google Scholar 

  35. Kennedy, D. M., Stratford, P. W., Wessel, J., Gollish, J. D., & Penney, D. (2005). Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskeletal Disorders, 6, 3. doi:10.1186/1471-2474-6-3.

    Article  PubMed  Google Scholar 

  36. Diehr, P., Chen, L., Patrick, D., Feng, Z., & Yasui, Y. (2005). Reliability, effect size, and responsiveness of health status measures in the design of randomized and cluster-randomized trials. Contemporary Clinical Trials, 26, 45–58. doi:10.1016/j.cct.2004.11.014.

    Article  PubMed  Google Scholar 

  37. Sloan, J., Symonds, T., Vargas-Chanes, D., & Fridley, B. (2003). Practical guidelines for assessing the clinical significance of health-related quality of life changes within clinical trials. Drug Information Journal, 37, 23–31.

    Google Scholar 

  38. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care, 41, 582–592. doi:10.1097/00005650-200305000-00004.

    Article  PubMed  Google Scholar 

  39. Guyatt, G. H., Juniper, E. F., Walter, S. D., Griffith, L. E., & Goldstein, R. S. (1998). Interpreting treatment effects in randomised trials. BMJ (Clinical Research Ed.), 316, 690–693.

    CAS  Google Scholar 

  40. Guyatt, G., & Schunemann, H. (2007). How can quality of life researchers make their work more useful to health workers and their patients? Quality of Life Research, 16, 1097–1105. doi:10.1007/s11136-007-9223-3.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all of the patients who contributed their views and time to this study.

Conflict of interest

This study received no external funding and none of the authors have any conflict of interest in relation to the study/paper.

Author information

Authors and Affiliations

  1. Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK

    Jill Dawson, Helen Doll, Irene Boller & Ray Fitzpatrick

  2. Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK

    Christopher Little

  3. Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK

    Jonathan Rees & Andrew Carr

Authors
  1. Jill Dawson
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  2. Helen Doll
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  3. Irene Boller
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  4. Ray Fitzpatrick
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  5. Christopher Little
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  6. Jonathan Rees
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  7. Andrew Carr
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Corresponding author

Correspondence to Jill Dawson.

Appendix

Appendix

The Oxford Elbow Score (OES) questionnaire:

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Dawson, J., Doll, H., Boller, I. et al. Comparative responsiveness and minimal change for the Oxford Elbow Score following surgery. Qual Life Res 17, 1257–1267 (2008). https://doi.org/10.1007/s11136-008-9409-3

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  • DOI: https://doi.org/10.1007/s11136-008-9409-3

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