{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:51:27Z","timestamp":1787755887119,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Short Musculoskeletal Function Assessment (SMFA) is a well validated, widely used patient-reported outcome (PRO) measure for orthopaedic patients. Despite its widespread use and acceptance, this measure does not have an agreed upon minimal clinically important difference (MCID). The purpose of the present study was to create distributional MCIDs with use of a large cohort of research participants with severe lower extremity fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Three distributional approaches were used to calculate MCIDs for the Dysfunction and Bother Indices of the SMFA as well as all its domains: (1) half of the standard deviation (one-half SD), (2) twice the standard error of measurement (2SEM), and (3) minimal detectable change (MDC). In addition to evaluating by patient characteristics and the timing of assessment, we reviewed these calculations across several injury groups likely to affect functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 4,298 SMFA assessments were collected from 3,185 patients who had undergone surgical treatment of traumatic injuries of the lower extremity at 60 Level-I trauma centers across 7 multicenter, prospective clinical studies. Depending on the statistical approach used, the MCID associated with the overall sample ranged from 7.7 to 10.7 for the SMFA Dysfunction Index and from 11.0 to 16.8 for the SMFA Bother Index. For the Dysfunction Index, the variability across the scores was small (&lt;5%) within the sex and age subgroups but was modest (12% to 18%) across subgroups related to assessment timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A defensible MCID can be found between 7 and 11 points for the Dysfunction Index and between 11 and 17 points for the Bother Index. The precise choice of MCID may depend on the preferred statistical approach and the population under study. While differences exist between MCID values based on the calculation method, values were consistent across the categories of the various subgroups presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.01201","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T15:51:05Z","timestamp":1719935465000},"page":"1767-1775","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Minimal Clinically Important Difference (MCID) for the Short Musculoskeletal Function Assessment (SMFA) in Severe Lower Extremity Trauma"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1419-4515","authenticated-orcid":false,"given":"Anthony R.","family":"Carlini","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-7389","authenticated-orcid":false,"given":"Julie","family":"Agel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, University of Washington Harborview Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7484-5282","authenticated-orcid":false,"given":"Michael J.","family":"Bosse","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5305-1774","authenticated-orcid":false,"given":"Katherine P.","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0620-0276","authenticated-orcid":false,"given":"Elena D.","family":"Staguhn","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3881-6518","authenticated-orcid":false,"given":"Heather A.","family":"Vallier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8942-1842","authenticated-orcid":false,"given":"William","family":"Obremskey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7036-1782","authenticated-orcid":false,"given":"Marc F.","family":"Swiontkowski","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5969-8018","authenticated-orcid":false,"given":"Lisa K.","family":"Cannada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Novant Health, University of North Carolina at Charlotte School of Medicine, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-8864","authenticated-orcid":false,"given":"Paul","family":"Tornetta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen J.","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5628-6584","authenticated-orcid":false,"given":"Robert V.","family":"O\u2019Toole","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5373-9197","authenticated-orcid":false,"given":"Lisa","family":"Reider","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8097-4555","authenticated-orcid":false,"given":"Lauren E.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4970-2428","authenticated-orcid":false,"given":"Susan C.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0473-5891","authenticated-orcid":false,"given":"Renan C.","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"METRC (Major Extremity Trauma Research Consortium)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,2]]},"reference":[{"issue":"9","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.2106\/00004623-199909000-00006","article-title":"Short Musculoskeletal Function Assessment questionnaire: validity, reliability, and responsiveness","volume":"81","author":"Swiontkowski","year":"1999","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/BOT.0b013e31815bb30f","article-title":"Current utilization, interpretation, and recommendations: the Musculoskeletal Function Assessments (MFA\/SMFA)","volume":"21","author":"Barei","year":"2007","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/0269215515579286","article-title":"Psychometric properties of the Musculoskeletal Function Assessment and the Short Musculoskeletal Function Assessment: A systematic review","volume":"30","author":"Bouffard","year":"2016","journal-title":"Clin Rehabil."},{"issue":"Suppl 1","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5435\/JAAOS-20-08-S59","article-title":"METRC Investigators. Measurement of functional outcomes in the Major Extremity Trauma Research Consortium (METRC)","volume":"20","author":"Castillo","year":"2012","journal-title":"J Am Acad Orthop Surg."},{"issue":"1","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1302\/2633-1462.21.BJO-2020-0150.R1","article-title":"Prognostic factors for predicting health-related quality of life after intramedullary nailing of tibial fractures: a randomized controlled trial","volume":"2","author":"Sprague","year":"2021","journal-title":"Bone Joint Open."},{"issue":"2","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"208","DOI":"10.2106\/00004623-200202000-00007","article-title":"The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population","volume":"84","author":"Hunsaker","year":"2002","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.jclinepi.2009.01.014","article-title":"Use of both Short Musculoskeletal Function Assessment questionnaire and Short Form-36 among tibial-fracture patients was redundant","volume":"62","author":"Busse","year":"2009","journal-title":"J Clin Epidemiol."},{"issue":"6","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.injury.2012.10.020","article-title":"Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires","volume":"44","author":"Dattani","year":"2013","journal-title":"Injury."},{"issue":"6","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1177\/1071100718757719","article-title":"Functional outcomes of symptomatic implant removal following ankle fracture open reduction and internal fixation","volume":"39","author":"Williams","year":"2018","journal-title":"Foot Ankle Int."},{"issue":"6","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1177\/1938640020923262","article-title":"Minimum clinically important difference in Short Musculoskeletal Function Assessment: What change matters in ankle fractures","volume":"14","author":"McCreary","year":"2021","journal-title":"Foot Ankle Spec."},{"issue":"6","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.injury.2018.04.031","article-title":"Long-term patient reported outcomes following acetabular fracture fixation","volume":"49","author":"Verbeek","year":"2018","journal-title":"Injury."},{"issue":"3","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1097\/OI9.0000000000000137","article-title":"Which general functional outcome measure does a better job of capturing change in clinical status in pelvic and acetabular fracture patients? An analysis of responsiveness over the first year of recovery","volume":"4","author":"Ko","year":"2021","journal-title":"OTA Int."},{"issue":"4","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"2473011419884008","DOI":"10.1177\/2473011419884008","article-title":"Comparison of generic, musculoskeletal-specific, and foot and ankle-specific outcome measures over time in tibial plafond fractures","volume":"4","author":"Sepehri","year":"2019","journal-title":"Foot Ankle Orthop."},{"issue":"5","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/01.MLR.0000062554.74615.4C","article-title":"Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation","volume":"41","author":"Norman","year":"2003","journal-title":"Med Care."},{"issue":"2","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jclinepi.2007.03.012","article-title":"Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes","volume":"61","author":"Revicki","year":"2008","journal-title":"J Clin Epidemiol."},{"issue":"5","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.jseint.2023.04.007","article-title":"American Shoulder and Elbow Surgeons score: what does it tell us about patients selecting operative treatment of a rotator cuff injury?","volume":"7","author":"Agel","year":"2023","journal-title":"JSES Int."},{"issue":"Suppl 1","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1097\/BOT.0000000000000804","article-title":"METRC. A prospective randomized trial to assess fixation strategies for severe open tibia fractures: Modern ring external fixators versus internal fixation (FIXIT study)","volume":"31","author":"O\u02bcToole","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1097\/BOT.0000000000000799","article-title":"METRC. Outcomes after severe distal tibia, ankle, and\/or foot trauma: Comparison of limb salvage versus transtibial amputation (OUTLET)","volume":"31","author":"Bosse","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1097\/BOT.0000000000000803","article-title":"METRC. Supplemental perioperative oxygen to reduce surgical site infection after high-energy fracture surgery (OXYGEN study)","volume":"31","author":"O\u02bcToole","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1097\/BOT.0000000000000796","article-title":"METRC. Predicting acute compartment syndrome (PACS): The role of continuous monitoring","volume":"31","author":"Schmidt","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1097\/BOT.0000000000000793","article-title":"METRC. Improving pain management and long-term outcomes following high-energy orthopaedic trauma (Pain study)","volume":"31","author":"Castillo","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/BOT.0000000000001492","article-title":"A Randomized Controlled Trial Comparing rhBMP-2\/Absorbable Collagen Sponge Versus Autograft for the Treatment of Tibia Fractures With Critical Size Defects","volume":"33","year":"2019","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1097\/BOT.0000000000000801","article-title":"METRC. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: A multicenter, randomized, controlled trial (VANCO study)","volume":"31","author":"O\u02bcToole","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"7","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/BOT.0000000000000549","article-title":"Building a Clinical Research Network in Trauma Orthopaedics: The Major Extremity Trauma Research Consortium (METRC)","volume":"30","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.spinee.2007.01.008","article-title":"Understanding the minimum clinically important difference: a review of concepts and methods","volume":"7","author":"Copay","year":"2007","journal-title":"Spine J."},{"issue":"4","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/0194599819852604","article-title":"Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures","volume":"161","author":"Sedaghat","year":"2019","journal-title":"Otolaryngol Head Neck Surg."},{"key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.jclinepi.2017.06.009","article-title":"Minimal important difference to infer changes in health-related quality of life-a systematic review","volume":"89","author":"Jayadevappa","year":"2017","journal-title":"J Clin Epidemiol."},{"issue":"4","key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1177\/03635465231152484","article-title":"The minimal clinically important difference changes greatly based on the different calculation methods","volume":"51","author":"Franceschini","year":"2023","journal-title":"Am J Sports Med."},{"issue":"11","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"e052338","DOI":"10.1136\/bmjopen-2021-052338","article-title":"Minimal clinically important difference in means in vulnerable populations: challenges and solutions","volume":"11","author":"Peacock","year":"2021","journal-title":"BMJ Open."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:52:11Z","timestamp":1787752331000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.23.01201"}},"subtitle":["Pooled Data from 7 Multicenter, Prospective Clinical Trials"],"short-title":[],"issued":{"date-parts":[[2024,7,2]]},"references-count":29,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.23.01201","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,2]]}}}