Reference database

Clinically important thresholds

A calculator that returns “64” has answered the easy half of the question. Whether 64 is acceptable, and whether a rise from 56 to 64 means anything, is what actually changes a decision — and the answer lives in 53 published threshold values scattered across hundreds of papers.

Every row below records the population and follow-up interval the threshold was derived in. That is not a detail: an MCID from an arthroplasty cohort does not transfer to an ACL reconstruction cohort, and a threshold quoted without its population is not usable.

Threshold values: 217
Change scores: 53
Instruments covered: 65
All cited: 100%

Type

Region

53 of 217 published thresholds

MCID — Minimal clinically important difference — the smallest change a patient perceives as meaningful.
MDC — Minimal detectable change — the smallest change exceeding measurement error.
PASS — Patient acceptable symptom state — the score above which patients consider their state acceptable.
SCB — Substantial clinical benefit — a substantial rather than minimal improvement.

Instrument	Type	Value	Subscale	Population	Follow-up	Source
ASES Score	MCID	6.4 points	—	Patients with shoulder pain of mixed cause receiving outpatient physical therapy	—	Michener LA 2002
ASES Score	MCID	12.0 to 17.0 points	—	Rotator cuff disease treated nonoperatively	—	Tashjian RZ 2010
Constant Score	MCID	10.4 points	—	Patients undergoing rotator cuff surgery	12 months	Kukkonen J 2013
FAAM	MCID	8 points	ADL	Adults with a broad range of leg, foot and ankle musculoskeletal disorders who self-rated as improved	—	Martin RL 2005
FAAM	MCID	9 points	Sports	Adults with a broad range of leg, foot and ankle musculoskeletal disorders who self-rated as improved	—	Martin RL 2005
FAAM	MDC	5.7 points	ADL	Adults with leg, foot and ankle musculoskeletal disorders, stable between administrations	—	Martin RL 2005
FAAM	MDC	12.3 points	Sports	Adults with leg, foot and ankle musculoskeletal disorders, stable between administrations	—	Martin RL 2005
FAOS	MCID	10 points	All subscales	Ankle disorders, by analogy with the KOOS	—	Roos EM 2001
FAOS	MDC	10–20 points depending on subscale	—	Chronic ankle instability	—	Sierevelt IN 2018
Harris Hip Score	MCID	≈ 18 points	—	Total hip arthroplasty	12 months	Singh JA 2016
HOOS	MCID	10 points	All subscales	Total hip arthroplasty	6–12 months	Nilsdotter AK 2003
HOOS	MCID	~9 points	Pain	Hip osteoarthritis, non-surgical	—	Nilsdotter A 2011
HOOS	MDC	10–16 points	Varies by subscale	Hip osteoarthritis	—	Nilsdotter A 2011
HOOS	PASS	~73 points	Pain	Hip arthroscopy for FAI	12 months	Nwachukwu BU 2017
HOS	PASS	≈ 87%	Activities of Daily Living	Arthroscopic surgery for femoroacetabular impingement	12 months	Chahal J 2015
HOS	PASS	≈ 75%	Sports	Arthroscopic surgery for femoroacetabular impingement	12 months	Chahal J 2015
KOOS	MCID	8–10 points	Pain	Total knee arthroplasty	6–12 months	Roos EM 2003
KOOS	MCID	8–10 points	ADL	Total knee arthroplasty	6–12 months	Roos EM 2003
KOOS	MCID	10 points	All subscales	ACL reconstruction	12 months	Roos EM 2003
KOOS	MDC	6–12 points	Varies by subscale	Knee osteoarthritis	—	Collins NJ 2011
KOOS	PASS	~78 points	Pain	Knee arthroplasty	12 months	Connelly JW 2019
KOOS	PASS	~63 points	QOL	Knee arthroplasty	12 months	Connelly JW 2019
LEFS	MCID	9 points	—	Adults with lower limb musculoskeletal dysfunction	—	Binkley JM 1999
LEFS	MCID	9 points	—	Knee osteoarthritis and post-arthroplasty	Rehabilitation episode	Stratford PW 2004
LEFS	MDC	9 points (90% confidence)	—	Adults with lower limb musculoskeletal dysfunction	—	Binkley JM 1999
Lysholm	MCID	8.9 points	—	Patients with chondral disorders of the knee	—	Kocher MS 2004
Marx	MDC	4.4 points	—	Patients with knee disorders	—	Marx RG 2001
NDI	MCID	7 raw points (14 percentage points)	—	Mechanical neck pain	—	Vernon H 2008
NDI	MCID	7.5 raw points	—	Cervical radiculopathy	—	Young IA 2010
NDI	MCID	~10 percentage points	—	Whiplash-associated disorder	—	MacDermid JC 2009
NDI	MDC	5–10 raw points	—	Neck pain, varies by study	—	MacDermid JC 2009
ODI	MCID	10 percentage points	—	Chronic low back pain	—	Fairbank JC 2000
ODI	MCID	12.8 points	—	Lumbar spine surgery	1 year	Copay AG 2008
ODI	MCID	30% change from baseline	—	Low back pain, IMMPACT consensus recommendation	—	Ostelo RW 2008
ODI	MDC	10–15 points	—	Chronic low back pain	—	Davidson M 2002
PSEQ	MCID	8.5 points	—	Chronic pain, multidisciplinary pain management programme	—	Chiarotto A 2015
PSEQ	MDC	11 points	—	Chronic low back pain	—	Chiarotto A 2015
QuickDASH	MCID	8 points	—	Upper limb musculoskeletal disorders	—	Beaton DE 2005
QuickDASH	MCID	15.91 points	—	Shoulder pain, physiotherapy	3–4 weeks	Mintken PE 2009
QuickDASH	MCID	~14 points	—	Rotator cuff repair	6–12 months	Kim JK 2014
QuickDASH	MDC	11.2 points	—	Upper limb musculoskeletal disorders	—	Mintken PE 2009
RMDQ	MCID	2–3 points	—	Acute low back pain	—	Jordan K 2006
RMDQ	MCID	5 points	—	Chronic low back pain	—	Jordan K 2006
RMDQ	MCID	30% change from baseline	—	Low back pain, recommended by the IMMPACT consensus	—	Ostelo RW 2008
RMDQ	MDC	4–5 points	—	Chronic low back pain	—	Stratford PW 1996
SPADI	MCID	8–13.2 points	—	Mixed shoulder pathology in orthopaedic and physiotherapy outpatients	4 weeks to 6 months	Roy JS 2009
SPADI	MCID	13.2 points	—	Shoulder pain managed in primary care and physiotherapy	6 weeks	Schmitt JS 2004
SPADI	MDC	Approximately 18 points (90% confidence)	—	Patients with shoulder pain, stable between assessments	—	Roy JS 2009
SST	MCID	2 points	—	Rotator cuff disease and shoulder arthroplasty	—	Roy JS 2010
SST	MCID	2.05 points	—	Total shoulder arthroplasty	2 years	Werner BC 2016
SST	MDC	2.8 points	—	Rotator cuff disease	—	Roy JS 2010
SST	SCB	4.1 points	—	Total shoulder arthroplasty	2 years	Werner BC 2016
Tegner	MCID	1 activity level	—	Patients with anterior cruciate ligament injury	—	Briggs KK 2009

How to use these

Match the population before you use the number. Thresholds are derived in a specific cohort at a specific follow-up interval. Applying an arthroplasty MCID to a sports population, or a 12-month PASS to a 6-week review, will mislead you.

MCID answers a different question from PASS. MCID asks whether a patient has changed enough to notice. PASS asks whether they have arrived somewhere acceptable. A patient can exceed the MCID and still be below the PASS — improved, but not yet well.

Check the change exceeds measurement error. Where an MDC is published and is larger than the MCID, a change smaller than the MDC cannot be distinguished from noise regardless of what the MCID says.

Where values conflict, we report the range. We do not pick a favourite among competing published estimates, and where no threshold has been published for an instrument we say so rather than borrowing one from a related measure.