Abstract
Objective
To define for 2 shoulder outcomes scales the substantial clinical benefit (SCB)—a
metric that defines the change amount associated with patient perception of a large
meaningful improvement and that can be used to interpret change over time in the outcome
score.
Design
Cohort.
Setting
Clinic.
Participants
Patients (N=74) with shoulder impingement syndrome.
Interventions
Standardized exercise and manual therapy for 6 weeks, and outcome measures completed
at initial evaluation, discharge, and 6 to 8 weeks postdischarge.
Main Outcome Measures
Disabilities of the Arm, Shoulder and Hand (DASH), Pennsylvania Shoulder Score (Penn),
and a 13-point Global Rating of Change (GROC). Patients were classified as “substantially
improved” when they reported “quite a bit better” (11) or greater on the GROC at discharge
and again 6 to 8 weeks after discharge. Patients with GROC <11 at discharge or follow-up
were classified as “nonsubstantially improved.” The percentage and raw points change
in the Penn and DASH that corresponded with patient-rated substantial improvement
was determined with receiver operator characteristic (ROC) analyses.
Results
ROC analyses revealed the SCB for the DASH was 40% (area under the curve [AUC]=.79;
confidence interval [CI], .69–.89) and 11 points (AUC=.63; CI, .50–.76); and for the
Penn, 20% (AUC=.76; CI, .65–.87) and 21 points (AUC=.80; CI, .69–.90).
Conclusions
The SCB of 40% for the DASH, and 20% and 21 points for the Penn represents substantial
improvement over 6 weeks of care, which was sustained at 12 weeks. The SCB of 11 points
for the DASH is not recommended for use because of poor discrimination. The SCB can
be used to enable clinical decision-making and in future clinical trials. Alternative
approaches such as the within- and between-group change values can produce different
SCB values.
Keywords
List of abbreviations:
AUC (area under the curve), CI (confidence interval), DASH (Disabilities of the Arm, Shoulder and Hand), GROC (Global Rating of Change), ICC (intraclass correlation coefficient), MCID (minimal clinically important difference), Penn (Pennsylvania Shoulder Score), ROC (receiver operating characteristic), SCB (substantial clinical benefit)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 19, 2012
Footnotes
Supported by the National Athletic Trainers' Association–Research and Education Foundation. This funding source was not involved in data collection, data analysis, or in the preparation of or editing of the manuscript.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
