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Cited by 510Total Knee Arthroplasty OutcomesOrthopaedic implants and arthroplastyHealth Systems, Economic Evaluations, Quality of Life

Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement

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Quintana, J.M., Escobar, A., Bilbao, A., Arostegui, I., Lafuente, I., Vidaurreta, I.·2005·Osteoarthritis and Cartilage
DOI 10.1016/j.joca.2005.06.012
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Abstract

Objectives To study responsiveness and establish the minimal clinically important differences (MCID) and minimal detectable change (MDC) in patients undergoing total hip replacement (THR) using the Short Form 36 (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Methods We conducted a prospective observational study in three public hospitals of all consecutive patients with a diagnosis of hip osteoarthritis (OA) on waiting lists to undergo THR. Patients completed the SF-36 and the WOMAC (subscales transformed to 0 to 100), which measured the health-related quality of life (HRQoL), before intervention and 6 months and 2 years later, and additional transitional questions, which measured the changes in the joint 6 months postoperatively.Results Improvements at 6 months after a THR were between 37 (stiffness) and 39 points (pain), depending on the WOMAC domain. The SF-36 domains also showed improvements: physical function (31.91), physical role (33.71), and bodily pain (29.77). From 6 months to 2 years, improvements ranged from 2 to 5 points, except for role physical (13.25). A ceiling effect was detected on some WOMAC domains as well as a floor effect on the SF-36. The MCID ranged from 25.91 (stiffness) to 29.26 (pain) on the WOMAC and from 10.78 (physical role) to 20.40 (physical function) on the SF-36. The MDC ranged from 21.38 (pain) to 27.98 (stiffness) on the WOMAC and from 18.99 (physical function) to 42.05 (social function) on the SF-36.Conclusions These values indicate expected gains after THR. However, the MCID and MDC values must be viewed cautiously due to the uncertainty of these estimators and should not be considered as absolute thresholds.

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  • The SDC or LOA can be used to augment traditional effect sizes, providing real-world information on treatment effects.

    “The SDC or LOA can be used to augment traditional effect sizes (e.g., Cohen ' s d ), providing real-world information on treatment effects (Quintana et al., 2005).”

    From Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ) (2023) · cites this paper as Quintana et al., 2005

    The Discussion (page not available in our copy) says that group-level effect sizes may not reflect clinically relevant individual gains, for which MCID and MDC are important. The Statistical Analysis section defines MDC as a threshold for change beyond measurement error. This supports the point about supplementing effect sizes with an individual-level measure, but the paper does not discuss LOA or use the term SDC. (LLM, conf=0.84)

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Research works printed but not linked: 3

  1. Nilsdotter AK, Roos EM, Westerlund JP, Roos HP, Lohmander LS. Comparative responsiveness of measures of pain and function after total hip re- placement. Arthritis Rheum 2001;45(3):258e62.
  2. Davies GM, Watson DJ, Bellamy N. Comparison of the responsiveness and relative effect size of the western Ontario and McMaster Universities Osteoarthritis In- dex and the short-form Medical Outcomes Study Survey in a randomized, clinical trial of osteoarthritis patients. Arthritis Care Res 1999;12(3):172e9.
  3. Nunnally JC, Berstein IH. Psychometric Theory. 3rd edn. New York: McGraw-Hill 1994.

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Authors
Quintana, J. M., Escobar, A., Bilbao, A., Arostegui, I., Lafuente, I., & Vidaurreta, I.
Affiliations
Hospital de Galdakao (ES)
Corresponding author
Quintana, J.M.
ORCID
Venue
Osteoarthritis and Cartilage
Publisher
Elsevier BV
Published
2005-12
Volume
13
Issue
12
Pages
1076-1083
ISSN
1063-4584 (ISSN-L)
DOI
10.1016/j.joca.2005.06.012
OpenAlex
W1976568108
Cited by
510
References
52
Citations by year
2026: 5 · 2025: 8 · 2024: 14 · 2023: 16 · 2022: 29 · 2021: 43 · 2020: 38 · 2019: 41 · 2018: 45 · 2017: 24 · 2016: 37 · 2015: 35 · 2014: 32 · 2013: 23 · 2012: 33
FWCI
6.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Osteoarthritis and Cartilage (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eusko Jaurlaritza
  • Instituto de Salud Carlos III
Topics
  • Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
  • Health Sciences › Medicine › Surgery › Orthopaedic implants and arthroplasty
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
total hip arthroplasty, hip osteoarthritis, WOMAC, SF-36, minimal clinically important difference, minimal detectable change, responsiveness, health-related quality of life, hip pain, hip stiffness, ceiling effect, floor effect, postoperative outcomes
MeSH terms
Aged, Female, Follow-Up Studies, Health Status Indicators, Hip Joint, Humans, Male, Middle Aged, Pain, Prospective Studies, Quality of Life, Osteoarthritis, Hip, Treatment Outcome, Arthroplasty, Replacement, Hip

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