Specificity of the minimal clinically important difference of the quick Disabilities of the Arm Shoulder and Hand (QDASH) for distal upper extremity conditions

• 406 participants, three diagnoses were assessed using triangulation methods.
• For surgical distal radius fracture the MCID = 25.8, MDC90 = 25.28, and AUC = 0.66.
• For non-surgical lateral epicondylitis the MCID = 15.8, MDC90 = 22.49, and AUC = 0.64.
• For carpal tunnel release the MCID = 18.7, MDC90 = 27.63, and AUC = 0.66.

Retrospective cohort design. The minimal clinically important difference (MCID) for the quick Disabilities of the Arm, Shoulder and Hand (QDASH) has been established using a pool of multiple conditions, and only exclusively for the shoulder. Understanding diagnoses-specific threshold change values can enhance the clinical decision-making process. Before and after QDASH scores for 406 participants with conditions of surgical distal radius fracture, non-surgical lateral epicondylitis, and surgical carpal tunnel release were obtained. The external anchor administered at each fourth visit was a 15-point global rating of change scale. The test-retest reliability of the QDASH was moderate for all diagnoses: intraclass correlation coefficient model 2, 1, for surgical distal radius = 0.71; non-surgical lateral epicondylitis = 0.69; and surgical carpal tunnel = 0.69. The minimum detectable change at the 90% confidence level was 25.28; 22.49; and 27.63 points respectively; and the MCID values were 25.8; 15.8 and 18.7, respectively. For these three distal upper extremity conditions, a QDASH MCID of 16–26 points could represent the estimate of change in score that is important to the patient and guide clinicians through the decision-making process.