Article

OBJECTIVE: To evaluate the responsiveness and minimal important changes (MICs)
for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
and its subscales in subjects with hip fractures. DESIGN: At the beginning and
end of a 2-month rehabilitation program, 106 patients completed the WOMAC. After
the program, the global perceived effect (GPE) was analyzed to produce a
dichotomous outcome (improved vs. stable). Responsiveness for the WOMAC and its
subscales were calculated by distribution (effect size; standardized response
mean) and anchor-based methods (receiver operating characteristic curves;
correlations between change scores of the WOMAC and its subscales and GPE).
Receiver operating characteristic curves were also used in order to compute the
best cutoff levels between improved and stable subjects (MICs). RESULTS: The
effect size ranged from 0.64 to 11.10 and the standardized response mean from
0.79 to 2.65. The receiver operating characteristic analyses revealed an MIC
value (area under the curve, sensitivity, specificity) for the WOMAC of 29
(0.817, 92, 78); values of 35 (0.820, 77, 76) 44 (0.625, 25, 95), and 24 (0.707,
100, 76) were found for pain, stiffness, and physical function subscales,
respectively. Correlations between change scores of the WOMAC and its subscales
and GPE were low (0.240, for stiffness subscale) to moderate (0.438-0.570 for the
other subscales and the WOMAC). CONCLUSIONS: The WOMAC and its subscales (all but
stiffness) were sensitive in detecting clinical changes in subjects with hip
fracture undergoing rehabilitation. We recommend taking the MICs provided into
account when assessing patients' improvement or planning studies in this clinical
context.

Langue : ANGLAIS