Minimum Clinically Important Difference Values for PROMIS PI and UE After Distal Radius Fractures in Operative vs. Non-Operative Procedures

Title: Minimum Clinically Important Difference Values for PROMIS PI and UE After Distal Radius Fractures in Operative vs. Non-Operative Procedures Authors: Michaela Rasmussen, Mary Zylinski, Nebiyat M. Girma, Rahul Bodapati, Charles S. Day Introduction: The minimum clinically important difference (MCID) is the smallest change after a procedure that is meaningful to the patient. However, there is limited data on the MCID for operative and non-operative treatment of distal radius fractures (DRF) which could provide objective data for both providers and patients, in treatment planning and postoperative counseling. Methods: This retrospective cohort study included patients treated for distal radius fractures (DRF) in 2020-2024 by fellowship-trained orthopedic trauma surgeons at an urban, academic health system. Patients undergoing additional procedures or with incomplete questionnaires were excluded. Preoperative surveys were taken on the day of surgery or the last recorded survey, while post-operation surveys were completed between 3 weeks to 3 months after surgery. The study used the PROMIS Upper Extremity (UE) and Pain Interference (PI) questionnaires. The MCID was calculated using a distribution-based method (0.5 and 0.8 times the standard deviation of changes in scores). The minimum detectable change (MDC) was also calculated (MDC95). The final MCID for each PRO instrument was defined as the median of the three methods. Results: For non-operative DRF, the mean difference was 6.7 (PROMIS UE) and –7.5 (PROMIS PI), while operative DRF had a mean difference of 7.6 (PROMIS UE) and –7.8 (PROMIS PI). The distribution-based MCID for operative DRF was 5.4 (PROMIS UE) and 5.7 (PROMIS PI) whereas for non-operative DRF the MCID was 6.8 (PROMIS UE) and 4.9 (PROMIS PI). Conclusions: Both PROMIS UE and PROMIS PI showed statistically significant improvements in both operative and non-operative treatments. The MCID differences suggest greater pain reduction is needed for operative procedures to be clinically significant, while increased functional improvement is required for non-operative treatments. These findings can guide orthopedic practice, helping physicians discuss expected outcomes with patients, enabling them to make more informed decisions about treatment options for DRF.