Outcomes Assessment in Wrist Surgery

A crucial part of any manuscript that is submitted to the Journal of Wrist Surgery is the outcomes assessment. The results of treatment have no meaning unless they are considered in light of the functional outcome. In order to report the result of an intervention, however, one must define the outcome that is being examined. For example, if the outcome assessed is the development of radiocarpal osteoarthritis, the results may be different if the assessed outcome is changed to wrist pain or grip strength. Furthermore, these outcomes may not take into account the patient's level of pain, their ability to carry out activities of daily living, or the ability to return to previous occupations.

Jaeschke and colleagues first described the concept of the minimal clinically important difference (MCID) in 1989.[1] The MCID was defined as the smallest difference in score in the domain of interest that patients perceive as beneficial, which would thus mandate a change in the patient's management. Their argument was that although statistically significant changes often occurred during the use of instruments that measured change after intervention, in some cases the significant change had little clinical significance. The measure of change must be reflective of a self-reported measure from a patient versus a clinical finding or statistical change. As Cook[2] opined, some of the difficulties with using the MCID include how to determine how much patient-reported change is beneficial, what is the best way to glean this query, and how one decides if the patient-reported change is sufficient. Unfortunately, MCIDs can vary widely depending on the method used, and there is currently no standard on how to calculate the MCID, which has led to a number of methodological or interpretation problems. As a consequence, the MCID is not commonly used in clinical studies on wrist surgery.

Scoring systems that evaluate subjective and objective factors together are frequently used to quantify wrist function after treatment from a physician's point of view. A number of validated outcomes evaluation measures have been developed, but it can be quite confusing as to which ones to use. One must first decide if they are measuring the whole or the parts and which region of the body to evaluate. In addition, there are physician-based scoring systems and patient-completed health status questionnaires.

• References

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