LAUSR

BACKGROUND The choice of outcome success thresholds may influence clinical management, pay-for-performance, and assessment of value-based care. OBJECTIVE To evaluate outcomes success thresholds in older adults using two different methods: 1) Minimal clinically important differences (MCIDs) of the Quick-DASH and 2) Dichotomization of the Quick-DASH based on low disability rating at discharge DESIGN: An observational design (retrospective database study). SETTING Dataset of 1109 patients with shoulder disorders. PARTICIPANTS 297 older adults patients who were diagnosed with rotator cuff related shoulder disorders and were managed through physical therapy treatment. MAIN OUTCOME MEASURES We categorized and calculated how many patients met 8.0 and 16.0 point changes on the Quick-DASH. To evaluate outcomes success thresholds using dichotomization, patients who discharge score of ≤20 on the Quick-DASH were considered positive responders with successful outcomes. RESULTS The percentage of positive responders who met the MCID thresholds for the Quick-DASH were 63.3% using MCID of 8.0 points, 39.7% using the MCID of 16.0 points, and 46.12% who met discharge score of ≤ 20 on the Quick-DASH. 39.0% met both MCID of 8.0 points and discharge score of ≤ 20 on the Quick-DASH. Only 28% met both MCID of 16.0 points and discharge score of = 20 on the Quick-DASH. CONCLUSION Three different success threshold derivations classified patients into three very different assessments of "success". Quick-DASH scores of ≤ 20 represent low levels of self-report disability at discharge and can be a stable clinical option for a measure of success to capture whether a treatment results in meaningful improvement.