Defining Significant Changes with Patient-Acceptable Symptom State Score and Minimal Clinically Important Difference in Japanese Patient-Reported Outcome Measures following Hip Arthroscopy

Abstract

Purpose

Japanese International Hip Outcome Tool 12 (iHOT12J) and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) have been used in patients with hip labral injuries. However, patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID) from iHOT12J and JHEQ have not been investigated. We analyzed PASS score and MCID between iHOT12J and JHEQ preoperatively and at 2 years postoperatively in patients underwent hip arthroscopy.

Materials and Methods

PASS score and MCID were calculated using pre- and two years post hip arthroscopy iHOT12J and JHEQ data from 99 patients. Anchor-based method was used to calculate PASS, which involved dividing patients into two groups based on their JHEQ satisfaction visual analog scale as well as performing receiver operating characteristic (ROC) curve analyses. ROC curve and PASS score were computed using obtained values and Youden index, respectively. Value with the greatest sensitivity and specificity was target value. MCID was calculated with 0.5 standard deviation (SD) method by dividing the mean of iHOT12J and JHEQ values, obtained from pre- and at two years post-surgery, by 0.5.

Results

PASS scores were 74.2 for iHOT12J and 62.0 for JHEQ. SD was 24.8% for iHOT12J and 19.4 for JHEQ. MCID was 12.4 for iHOT12J and 9.7 for JHEQ. Achievement rates of PASS and MCID were 73/99 (73.7%) for iHOT12J and 89/99 (89.9%) for JHEQ.

Conclusion

PASS score and MCID could serve as measurable benchmarks to define significance in patient-reported outcome measure values for clinical outcomes or variables of postoperative hip arthroscopy.

INTRODUCTION

With promising postoperative results in patients with femoroacetabular impingement (FAI), hip arthroscopy has gained worldwide recognition. Patient-reported outcome measures (PROMs) as a clinical assessment tool for hip arthroscopy are gaining in popularity¹⁾. Currently, papers on hip arthroscopy incorporate PROMs¹⁾. In general, PROMs are completed by patients and differ from clinician-reported outcome measures that are evaluated by medical professionals²⁾. However, many PROMs were developed exclusively in countries where English is the primary language. Therefore, it is imperative to develop and demonstrate the utility of multilingual PROMs³⁾. We translated the International Hip Outcome Tool 12 (iHOT12) into Japanese (iHOT12J) and also demonstrated the utility of the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ), developed as a PROM for hip disease, to evaluate patients with hip labral injuries^4-6).

Patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID) are two concepts that have recently received attention. Their boundary values denote clinical significance and importance of outcome measures or symptoms^7,8). PASS is the lowest cutoff value of PROMs at which patients consider their symptom status as satisfactory. MCID is defined as the smallest clinically significant change in outcomes observed between the pre- and posttreatment phases. In the case of surgery, the MCID is the smallest difference between preoperative and postoperative PROMs that indicate either a significant improvement or deterioration of symptoms⁹⁾. By focusing on what the patients themselves consider to be an important improvement or deterioration, the MCID helps to bridge the gap between purely numerical results and real clinical relevance. In contrast to the MCID, PASS represents an absolute value rather than a change in value. Thus, the predefined PASS criteria can be compared to PROMs at any point in time^10-12).

With regards to the use of PASS and MCID in clinical practice, Tubach et al.¹⁰⁾ estimated the PASS score using the anchor question method in patients with knee and hip osteoarthritis following 4 weeks of medication. The PASS and MCID were recently used to assess PROMs in patients who had undergone hip arthroscopy. Chahal et al.¹²⁾ investigated the PASS of the modified Harris hip score (HHS) and hip outcome score (HOS) in patients with FAI undergoing arthroscopic hip surgery. It is useful to establish boundary values for each disease and to create absolute values that reflect patient satisfaction with treatment. We previously utilized PROMs, such as iHOT12J and JHEQ in patients undergoing hip arthroscopic surgery^4,6). In this study, we hypothesized that calculating PASS scores and MCID would allow us to evaluate the clinical significance of the variables assessed in these PROMs. Thus, we evaluated the PASS score and MCID from the iHOT12J and JHEQ PROM values obtained from patients prior to and two years following hip arthroscopy.

MATERIALS AND METHODS

1. Patient Selection and Study Design

From August 2013 to December 2020, 138 patients had hip arthroscopy at Hirakata City Hospital, Japanese Red Cross Sendai Hospital, and Tosei General Hospital. We collected the iHOT12J and JHEQ results from these patients. With regards to patient selection and exclusion criteria, we excluded 35 patients due to insufficient data. Furthermore, we excluded four patients who were injured in traffic or workplace accidents because patients receiving private medical care may exaggerate their pain and could be biased. The final cohort included 99 patients with complete data and a 2-year follow-up post surgery (Fig. 1). Of the 99 hip arthroscopic surgeries, 47 surgeries were performed at Hirakata City Hospital, 7 at Japanese Red Cross Sendai Hospital, and 45 at Tosei General Hospital. In terms of diagnosis, 85 patients had FAI hips (mixed: 54 hips, cam: 24 hips, pincer: 7 hips)¹³⁾, seven had borderline developmental dysplasia of the hip (BDDH), and four had osteoarthritis. The remaining three hips had other pathologies, including two with osteochondral lesions and one with FAI and exostosis (Fig. 1). The Japanese Hip Society’s FAI criteria were used to define cam FAI and pincer FAI¹³⁾. The BDDH was defined as a lateral center edge angle of 20° to 25°. Osteoarthritis, defined as Tonnis grade >1, does not meet the Japanese Hip Society’s FAI criteria. The postoperative rehabilitation protocol was shared among hospitals. For patients who had hip arthroscopy surgery, weight management and range of motion exercises were done with crutches for 4 to 6 weeks. The patients were able to resume sports and other physical activities 16 weeks following surgery. The local Research Ethics Committee approved this study that was conducted according to the guidelines of the Declaration of Helsinki (approval No. 1005). All patients provided written informed consent prior to enrollment.

Fig. 1.

Overview of patient selection. FAI: femoroacetabular impingement, BDDH: borderline developmental dysplasia of the hip joints.

2. Data Analysis

The anchor-based method was used to calculate PASS, as previously described¹⁴⁾. The postoperative satisfaction group was defined as those with a PASS satisfaction visual analog scale (VAS) ≥81, indicating a JHEQ satisfaction VAS <20. The JHEQ satisfaction criteria for VAS ranges from a maximum value of 0 to a minimum value of 100, based on the report by Beck et al.¹⁵⁾, who showed that the PASS satisfaction VAS during hip arthroscopy was 80.9 or higher.

The receiver operating characteristic (ROC) analysis and Youden’s index were used to calculate the PASS threshold for each PROM¹⁶⁾. Following the calculation, Youden’s index (calculated as sensitivity+specificity) was used to maximize the sensitivity and specificity of the threshold score along the ROC curve’s point coordinates. The point with the highest Youden’s index was chosen as the threshold score. The target value had the value with the highest sensitivity and specificity. An area under the curve greater than 0.8 indicated excellent performance.

To calculate the MCID, we used the 0.5 standard deviation (SD) method rather than the anchor-based method. There exists no consensus or gold standard to calculate the MCID even though the anchor-based method is commonly used. The 0.5 SD method was used to calculate MCID for the modified HHS, HOS, and International Hip Outcome Tool (iHOT-33) in patients who received arthroscopic treatment for hip acetabular impingement syndrome^17,18). Studies on PROM research in Asian countries are limited. It is also unclear whether changes in the Likert scale for Japanese people can be analyzed the same way as the anchor method. Furthermore, many Japanese people are hesitant to clearly express their satisfaction or dissatisfaction. Therefore, we used the 0.5 SD method rather than the anchor method to calculate the MCID in this study. We first calculated the SD from the preoperative and 2-year postoperative mean values of iHOT12J and JHEQ. We then divided this SD value by 0.5^5,19).

By using the PASS and MCID achievement rates as indicators, healthcare professionals will be able to appropriately evaluate the effectiveness of treatment and adjust treatment methods. Therefore, we calculated the achievement rates of PASS and MCID in iHOT12J and JHEQ. Using the chi-square test and nonparametric tests, we compared the PASS-achieved with the non-PASS achieved iHOT12J and JHEQ groups for the following variables: surgical method, surgical time, age, body mass index (BMI), preoperative activity level assessed by the Tegner Activity Score, pathology, sex, operated side (left or right), and degree of FAI joint deformity assessed by the Tonnis classification.

The IBM SPSS software (ver. 25.0; IBM Corp.) was used to analyze all the data. ROC curves were generated for JHEQ satisfaction criteria of VAS 20 or lower. The SD values were calculated from the preoperative and postoperative means. In reference to the normal distribution of data, the Shapiro–Wilk test revealed P<0.05 for each parameter. This study employed nonparametric tests. On the basis of studies that indicate the requirement of a sample size of 75 to 100²⁰⁾, we aimed for 140 patients with a dropout rate of approximately 30%. We carried out post hoc power analysis using G*Power software for logistic regression analysis²¹⁾. The power of the study was calculated using G*Power 3.1 with a 0.05 error and a 99-person total sample size in the current study to yield a power of 0.936.

RESULTS

The study included 48 males and 51 females. Fifty-five patients had surgery in their right hip joint, while 44 patients had left hip joint surgery. The mean age was 38.15±13.42 years (range, 13-60 years). The mean BMI was 22.22±2.97 kg/m² (range, 16.4-32.4 kg/m²). The mean surgical procedure time was 134.96±33.89 minutes (range, 50-227 minutes). The mean follow-up period was 23.95±3.20 months (range, 16-38 months) with 81% of patients well within the period of 2 years (±3 months) following surgery. Cam osteoplasty and hip labrum repair were performed on 91/99 (91.9%) and 89/99 (89.9%) hips, respectively. Labrum debridement and capsule closure were performed on 3/99 (3.0%) and 92/99 (92.9%) hips, respectively. The mean postoperative follow-up period was 23.59±3.20 months (range, 16-38 months).

The AUC (area under the curve) of the ROC curve of iHOT12J was 0.929 and that of JHEQ was 0.904, which exceeded the target of 0.8 and were considered excellent (Fig. 2).

Fig. 2.

Receiver operating characteristic curves of iHOT12J (A) and JHEQ (B) at 2 years post hip arthroscopy. iHOT12J: Japanese International Hip Outcome Tool 12, JHEQ: Japanese Orthopedic Association Hip Disease Evaluation Questionnaire, AUC: area under the curve.

According to Youden index calculations, the point with the highest sensitivity and specificity for iHOT12J is 0.928 and 0.700, respectively. The PASS score of iHOT12J is 74.2. Similarly, JHEQ has sensitivity and specificity of 0.928 and 0.700, respectively, yielding a PASS score of 62.0 (Table 1).

Table 1.

PASS, PASS Achievement Rate, and MCID

	PASS (mean)	PASS achievement rate (%)	Preoperative (mean)	2-year postoperative (mean)	SD	MCID (=1/2 SD)	MCID achievement rate (%)
iHOT12J	74.2	73.7	37.8	82.9	24.8	12.4	89.9
JHEQ	62.0	73.7	36.1	71.1	19.4	9.7	89.9

PASS: patient-acceptable symptom state, MCID: minimal clinically important difference, SD: standard deviation, iHOT12J: Japanese International Hip Outcome Tool 12, JHEQ: Japanese Orthopedic Association Hip Disease Evaluation Questionnaire.

In contrast, based on the iHOT12J preoperative mean of 37.8 and postoperative mean of 82.9, the SD was 24.8 and MCID was 12.4. Similarly, based on the JHEQ preoperative mean of 36.1 and postoperative mean of 71.1, the SD was 19.4 and MCID was 9.7 (Table 1). The PASS threshold was achieved by 73 out of 99 patients (73.7%) for both iHOT12J and JHEQ. The MCID threshold was achieved by 89 out of 99 patients (89.9%) for both iHOT12J and JHEQ (Table 1).

We also compared the PASS-achieved group (PASS-A: n=73) with the nonachieved group (PASS-N: n=26) in both iHOT12J and JHEQ using chi-square and nonparametric tests, respectively. For iHOT12J, there were considerably fewer women in the iHOT12J PASS-achieved group (PASS-N: 61.5% [n=16], PASS-A: 47.9% [n=35], P<0.05). With regards to the operated side of the hip, there were considerably more left-sided patients in the iHOT12J PASS-achieved group (PASS-N: 42.3% [n=11], PASS-A: 45.2% [n=33], P<0.05). Furthermore, these two groups differed significantly in terms of pathology, specifically in the percentage of FAI and the degree of joint deformity (Table 2). There were no significant differences between PASS-nonachieved and PASS-achieved groups for age (PASS-N: 43.4±12.9 years, PASS-A: 38.1±13.7 years, P=0.098), BMI (PASS-N: 22.8±3.07 kg/m², PASS-A: 22.0±2.95 kg/m², P=0.187), preoperative activity levels – Tegner Activity Score (PASS-N: 4.81±1.50, PASS-A: 5.16±1.63, P=0.500), surgical procedures (cam osteoplasty – PASS-N: 96.2% [n=25], PASS-A: 90.4% [n=66], P=0.326; labrum repair – PASS-N: 92.3% [n=24], PASS-A: 89.0% [n=65]; labrum debridement – PASS-N: 0% [n=0], PASS-A: 4.1% [n=3]; labrum others – PASS-N: 7.7% [n=2], PASS-A: 6.8% [n=5], P=0.857; capsule repair – PASS-N: 96.2% [n=25], PASS-A: 91.8% [n=67], P=0.407) and surgical procedure time (PASS-N: 130.7±38.4 minutes, PASS-A: 135.5±32.5 minutes, P=0.362).

Table 2.

Comparison of iHOT12J PASS Achieved Group and Nonachieved Groups

	iHOT12J PASS nonachievement (n=26)	iHOT12J PASS achievement (n=73)	P-value
Disease classification
FAI mixed	12 (46.2)	42 (57.5)	<0.05
FAI cam	8 (30.8)	16 (21.9)	<0.05
FAI pincer	1 (3.8)	6 (8.2)	<0.05
BDDH	2 (7.7)	5 (6.8)	<0.05
OA	1 (3.8)	3 (4.1)	<0.05
Others	2 (7.7)	1 (1.4)	<0.05
Tonnis classification (grade)	0:1:2=20:5:1	0:1:2=57:13:3	<0.05
JHEQ PASS achievement	5 (19.2)	68 (93.2)	<0.05

Values are presented as number (%) or number only.

iHOT12J: Japanese International Hip Outcome Tool 12, PASS: patient-acceptable symptom state, FAI: femoroacetabular impingement, BDDH: borderline developmental dysplasia of the hip, OA: osteoarthritis of the hip, JHEQ: Japanese Orthopedic Association Hip Disease Evaluation Questionnaire.

When comparing the JHEQ PASS-achieved group with the PASS-nonachieved group, the JHEQ PASS achieved group had significantly fewer women (PASS-N: 57.7% [n=15], PASS-A: 49.3% [n=36], P<0.05). With regards to the operated side of the hip, the JHEQ PASS-achieved group had a significantly higher proportion of left-sided patients (PASS-N: 50.0% [n=13], PASS-A: 42.5% [n=31], P<0.05). There were notable variations in pathology, especially in the percentage of FAI and the degree of joint deformity between these two groups (Table 3). There were no significant differences in age (PASS-N: 43.8±12.0 years, PASS-A: 37.9±13.9 years, P=0.069), BMI (PASS-N: 22.9±3.13 kg/m², PASS-A: 22.0±2.91 kg/m², P=0.148), preoperative activity levels (PASS-N: 4.62±1.50, PASS-A: 5.23±1.63, P=0.243), surgical procedures (cam osteoplasty – PASS-N: 92.3% [n=24], PASS-A: 91.8% [n=67], P=0.649; labrum repair – PASS-N: 88.5% [n=23]; PASS-A: 90.4% [n=66], labrum debridement – PASS-N: 0% [n=0]; PASS-A: 4.1% [n=3], labrum others – PASS-N: 11.5% [n=3]; PASS-A: 5.5% [n=4], P=0.400; capsule repair – PASS-N: 92.3% [n=24]; PASS-A: 93.2% [n=68], P=0.593) and surgical procedure time (PASS-N: 140.5±41.3 minutes; PASS-A: 132.9±31.1 minutes, P=0.491).

Table 3.

Comparison of JHEQ PASS Achieved Group and Nonachieved Groups

	JHEQ PASS non achievement (n=26)	JHEQ PASS achievement (n=73)	P-value
Disease classification
FAI mixed	11 (42.3)	43 (58.9)	<0.05
FAI cam	6 (23.1)	18 (24.7)	<0.05
FAI pincer	0 (0.0)	7 (9.6)	<0.05
BDDH	5 (19.2)	2 (2.7)	<0.05
OA	2 (7.7)	2 (2.7)	<0.05
Others	2 (7.7)	1 (1.4)	<0.05
Tonnis classification (grade)	0:1:2=19:6:1	0:1:2=58:12:3	<0.05
iHOT12J PASS achievement	5 (19.2)	68 (93.2)	<0.05

Values are presented as number (%) or number only.

JHEQ: Japanese Orthopedic Association Hip Disease Evaluation Questionnaire, PASS: patient-acceptable symptom state, FAI: femoroacetabular impingement, BDDH: borderline developmental dysplasia of the hip, OA: osteoarthritis of the hip, iHOT12J: Japanese International Hip Outcome Tool 12.

The postoperative complications observed in the hips include lateral femoral cutaneous nerve palsy (n=7), pudendal nerve palsy (n=1), deep peroneal nerve palsy (n=1), and heterotopic ossification (n=4).

DISCUSSION

In this study, we computed the PASS scores and MCID of iHOT12J and JHEQ outcomes of patients prior to and following hip arthroscopy. Currently, PROMs are regarded as standard procedure to clinically assess several illnesses²⁾. Although substantial clinical benefit (SCB) is also significant among PROMs, we could not obtain an SCB because the questionnaire items were unavailable for this study⁷⁾.

Several methods have been used to compute the PASS score and MCID. For the PASS calculation, we used the VAS of satisfaction as the anchor question, which is integrated with the JHEQ score. Beck et al.¹⁵⁾ defined PASS in hip arthroscopy as a VAS score ≥80.9. Other studies calculated the PASS of PROMs and found that patients who scored higher than that value (VAS score ≥80.9) were considered to have achieved PASS^12,22).

In a 10-year evaluation with FAI, Gilat et al.²³⁾ defined the achieved PASS using Beck’s method of satisfaction VAS. Two years following hip arthroscopy, Yang et al.²⁴⁾ and Ju et al.²⁵⁾ calculated an iHOT12 PASS of 72.2 in patients. On the other hand, the MCID was calculated using several methods. Some reports calculated the MCID by analyzing satisfied subjects on a 5-point Likert scale: “excellent,” “very well,” “well,” “fair,” and “poor”^26,27). Our study did not directly apply the findings of the studies in native English-speaking countries. Furthermore, our study did not employ methods, such as the Likert scale, to assess the satisfaction level with each anchor question. In contrast, previous studies reported that the MCID was calculated from 0.5 SD of pre- and post-surgery PROM values^5,28,29). Therefore, we calculated the SD using the overall population’s pre- and postoperative PROM values and divided it by half⁵⁾. Our study found that the rate of achievement of PASS was 73.7% for iHOT12J, which was comparable to the 74.9% achieved two years post hip arthroscopy in a previous paper³⁰⁾ (Table 4). Furthermore in our study, the JHEQ PASS achievement rate was roughly 73.7%. Taking these observations into account, we confirmed the validity of the current results. In contrast, our study found that 89.9% of participants achieved MCID two years post hip arthroscopy. We also found that the mean age was 38.15 years, the proportion of women was 51.5%, and the mean BMI was 22.22 kg/m². Generally, it has been reported that iHOT12 improves upto nearly two years following surgery³¹⁾. It was also found that young age, male sex, and low BMI at the time of surgery are linked to better postoperative outcomes following hip arthroscopy³²⁾. Thus, it is likely that young age, low BMI, and male sex have a positive impact on postoperative outcomes in hip arthroscopy, resulting in a high MCID achievement rate.

Table 4.

Summary of iHOT12 PASS and MCID, PASS Achievement Rate, and Questionary Methods for Patients Underwent Hip Arthroscopy

Study	Postoperative PASS of iHOT12	PASS achievement rate (%)	Postoperative MCID of iHOT12	Questionary methods	Country
Kivlan et al.22)	75.2 at 1 year	53	N/R	Comparison of mHHS and HOS-ADL	USA
Nwachukwu et al.31)	63.0 at 1 year	63.3	13.0 at 1 year	Anchor question*	USA
Robinson et al.33)	64.0 at 1 year	63.9	12.54 at 1 year	Anchor question†	UK
Nwachukwu et al.30)	72.2 at 2 years	74.9	13.9 at 2 years	Anchor question‡	USA
Yang et al.24)	72.2 at 2 years	73.4	13.73 at 2 years	Using Satisfaction VAS§	China

iHOT12: International Hip Outcome Tool 12, PASS: patient-acceptable symptom state, MCID: minimal clinically important difference, N/R: not recorded, mHHS: modified Harris hip score, HOS: hip outcome score, ADL: activities of daily living, VAS: visual analog scale, USA: United States of America, UK: United Kingdom.

*Anchor question: “Satisfactory? Yes or No.”

^†Anchor question: “Would you recommend similar treatment to your friends or family?”

^‡Anchor question: “Is your current state satisfactory?”

^§Satisfaction VAS over 80 point is defined PASS.

In our study, the 2-year postoperative PASS score for iHOT12J was 74.2. A previous arthroscopy study found that the 1-year postoperative PASS score for iHOT12 was 75.2 when the HOS was used as an anchor²²⁾. Nwachukwu et al.³⁰⁾ reported a 2-year postoperative PASS score of 72.2. In contrast, relatively low 1-year postoperative PASS values of 63.0 and 64.0 were reported^31,33) (Table 4). However, iHOT12 scores <56 were considered abnormal³⁴⁾. Therefore, these low-60 values appear to be slightly low for PASS. Furthermore, iHOT12 PASS scores vary from 60-86⁵⁾. Martin et al.³⁵⁾ found that the PASS scores for iHOT12 were 60, 71, and 86 for patient satisfaction rates of 50%, 75%, and 100%, respectively. Since our method uses the JHEQ’s satisfaction VAS that indicates a satisfaction level of around 80%, 74.2 falls within this range. Regarding MCID score, the 2-year postoperative MCID for iHOT12J was 12.4 in this study. It has been reported that the 1-year postoperative MCID for iHOT12 was 12.54 or 13.0, and the 2-year MCID was 13.73 or 13.9 (Table 4)^24,30,31,33). Therefore, it is likely that the MCID threshold or acceptable range for iHOT12J and iHOT12 seems similar. However, the MCID score for JHEQ has not been previously reported. Similar to the MCID for iHOT12J, we believe that the MCID for JHEQ would be an important indicator for measuring patients’ postoperative satisfaction and degree of improvement.

PROMs are commonly used to evaluate the health of patients and their response to treatment. The significance of translating PROMs and validating their implementation has been demonstrated in various cultural contexts in non-English-speaking populations^4,6,36-41). The iHOT12 was developed in non-English-speaking countries and was reported in Swedish³⁶⁾, Dutch³⁷⁾, German³⁸⁾, Greek³⁹⁾, French⁴⁰⁾, and Korean⁴¹⁾ languages. All translated versions of the questionnaire had a Cronbach’s alpha of 0.89 or higher, indicating strong internal consistency. Furthermore, we previously validated the Japanese version of the iHOT12 (with a Cronbach’s alpha of 0.90)⁴⁾. Therefore, PROMs like iHOT12 can be translated and adapted to the cultural context of non-English-speaking countries. This ensures the reliability and validity of translated PROMs that help to accurately evaluate the effectiveness of medical interventions across cultures.

Our study has several limitations. First, the sample size is quite small. In this study, we examined the data used to calculate the PASS score and MCID both prior to and two years following surgery. McGovern et al.⁴²⁾ found that iHOT evaluation values can change from 1 to 2 years post surgery. Thus, we focused on the results of patients who were followed up for a mean of two years following surgery rather than those who were evaluated one year postoperatively. In contrast, given the need for a response, a sample size of 75 to 100 has been found to be adequate²¹⁾. Second, we did not establish general anchor questions. With regards to the degree of satisfaction with the surgery on the Likert scale, the questions asked were rated as “very satisfied,” “satisfied,” “unchanged,” “dissatisfied,” and “very dissatisfied.” Thus, the satisfaction VAS included in the JHEQ can serve as a sufficient substitute. Furthermore, according to Beck’s report on satisfaction VAS, the standard for PASS was a score of ≥80 or higher. The MCID is typically calculated using an anchor question. The 0.5 SD method is also widely used, but it is less reliable than anchor-based methods that directly correlate changes in PROM scores with patient-reported improvement. Distribution-based methods do not consider the patient’s perspective on what constitutes a significant improvement. Furthermore, the precision of the MCID calculated using the 0.5 SD method may not accurately reflect its clinical significance. It is also worth noting that the 0.5 SD threshold was chosen arbitrarily and may not correspond to what patients perceive as a meaningful improvement. Since no anchor question was established in this study, the MCID was calculated using the previously described distribution method⁴³⁾.

CONCLUSION

In patients who underwent hip arthroscopic surgery, the PASS values were 74.2 for iHOT12J and 62.0 for JHEQ, while those for MCID were 12.4 for iHOT12J and 9.7 for JHEQ. The achievement rates of PASS and MCID for iHOT12J and JHEQ were 73.7% and 89.9%, respectively. Young age, low BMI, and male sex may improve postoperative outcomes in hip arthroscopy.