Objective

The HFS is a pictorial questionnaire with 62 items; it is a self-report functional capacity evaluation of the upper limb . The MCID is important in assessing the effectiveness of a therapy. It has not been estimated for HFS-F . The aim of this study was to estimate the MCID of the HFS-F for patients hospitalized in musculoskeletal rehabilitation for chronic pain of the upper limb. As a comparison, the MCID of the DASH (disabilities of the arm, shoulder and hand) was also estimated.

Material/patients and methods

French speaking patients (18–65 years), hospitalized from January 1, 2012 to June 30, 2015, various pathology of upper limb in the aftermath of an accident. The pain has at least lasted three months. Reports: of HFS-F scores and DASH at the entrance and exit, of the global scale of change (Likert 7 levels) at the exit. The MCID was estimated using two methods: the subjective feeling of patient (ANOVA-ROC) and the objective method based on the distribution of scores (standard error of measurement: SEM).

Results

Two hundred and twenty five patients were enrolled, 82% men, age 43 ± 12 years, 65% proximal damage (shoulder, elbow), 35% distal damage (hand-wrist). The difference of the scores in subjectively improved patients was 26/248 (ANOVA, P < 10 ^-4 ), the values of sensitivity/specificity were 0.51–0.81 for the threshold values of MCID between 25/248 and 30/248 (area under the ROC curve (AUC) = 0.72 [0.65–0.78]). The SEM gave a value of 28/248. The difference in the DASH scores in subjectively improved patients was −12/100 ( P < 10 ^-4 ), corresponding to the MCID commonly accepted for this questionnaire , the values of sensitivity/specificity were 0.25–0.54 for DASH values of −13/100 at −11/100 (AUC = 0.31 [0.24–0.37]).

Discussion – conclusion

Both used methods are consistent to propose a MCID forHFS-Fbetween 25/248 and 30/248, corresponding to 11% improvement of the score. This estimate is useful in clinical practice. In this sample, the DASH seems less relevant to determine patients subjectively improved.