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Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients

N Holtz, D F Hamilton, J M Giesinger, Bernhard Jost & Karlmeinrad Giesinger

abstract

BACKGROUND
Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. Patient reported-outcome measures (PROMs) capture the patients' perception of the success of an intervention. The minimal important difference (MID) is an important characteristic of the PROM, which helps to interpret results. The aim of this study was to identify the MID for the Forgotten Joint Score-12 (FJS-12) and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.

METHODS
Data were collected in a prospective cohort study. Patients were asked to complete the FJS-12, WOMAC osteoarthritis index and transition items evaluating change over time to determine the MID. We employed an anchor-based methodology relating score change to the response categories of the transition items using both binary logistic regression and receiver operating characteristic (ROC) analysis.

RESULTS
Data from 199 patients were analysed. Mean age was 72.3 years, 58% were women. Employing binary logistic regression the MID for the FJS-12 was 10.8 points, for the WOMAC pain score 7.5 points and for the WOMAC function score 7.2 points. ROC analyses found a MID of 13.0 points for the FJS-12, 12.5 points for WOMAC pain and 14.7 points for WOMAC function.

CONCLUSION
We report MIDs for the FJS-12 and the WOMAC Pain and Function scales in a TKA patient cohort, which can be used to interpret meaningful differences in score. In line with previous research, we found more advanced statistical methods to result in smaller MID estimates for both scores.

TRIAL REGISTRATION
Written consent for this study was obtained from all participants and ethical approval was granted by the local ethics committee (Ethikkommission St. Gallen; EKSG 14/973; Registered 03 July 2014; http://www.sg.ch/home/gesundheit/ethikkommission.html).
   
citation Holtz N, Hamilton D F, Giesinger J M, Jost B, Giesinger K. Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients. BMC Musculoskelet Disord 2020; 21:401.
   
type journal paper/review (English)
date of publishing 23-06-2020
journal title BMC Musculoskelet Disord (21/1)
ISSN electronic 1471-2474
pages 401
PubMed 32576163
DOI 10.1186/s12891-020-03415-x