Clinically Relevant Thresholds in Patient-Reported Outcomes: Do Patients' Expectations Evolve Over Long-term Follow-up?
Authors
Walsh EG, McCarroll TR, Kuhns BD, Kahana-Rojkind AH, Quesada-Jimenez R, Domb BG
Background
Clinically relevant thresholds such as the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) help interpret the significance of patient-reported outcome scores following hip arthroscopy. However, how these thresholds and patient expectations change over long-term follow-up remains unclear.
Methods
This retrospective study included 414 hips from patients who underwent primary hip arthroscopy between 2008 and 2021. Patients with complete PRO data at 2-, 5-, or 10-year follow-up were included. Groups were propensity score–matched to control for confounding. Thresholds for MCID, PASS, and SCB were calculated using anchor-based methods for the modified Harris Hip Score (mHHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12).
Key Findings
- The percentage of patients achieving PASS and SCB increased from 2 to 10 years.
- PASS thresholds varied over time:
- mHHS: 77.5 (2 yrs), 85.5 (5 yrs), 78.5 (10 yrs)
- HOS-SSS: 82.7, 76.4, 67.7
- iHOT12: 67.4, 76.9, 62.9
- SCB thresholds also changed:
- mHHS: 95, 99, 88
- HOS-SSS: 97, 80.9, 90.5
- iHOT12: 89.4, 94.1, 82.5
- MCID values remained stable over time, and high percentages of patients achieved MCID across all intervals.
Conclusion
Patients consistently achieved clinically meaningful improvement after hip arthroscopy, with thresholds like PASS and SCB evolving over time. The increase in PASS/SCB achievement at 10 years may reflect a shift in patient expectations, suggesting that patients may recalibrate their perceptions of success over the long term.
What Does This Mean For Patients
Even years after surgery, patients report meaningful improvements in pain and function. Over time, patients may adjust their expectations, making it more likely for them to feel satisfied with their results. This insight helps both patients and surgeons better understand what to expect in the long term following hip arthroscopy.