Ability to detect change in patient function: Responsiveness designs and methods of calculation

In hand clinics, the goal of enabling patient improvement is fostered by the use of assessments with the ability to detect change (responsiveness). Thus, for commonly used assessments, investigations are needed to determine a standardized change index, the amount of change exceeding error estimates (minimal detectable change or MDC), and the amount of change shown to make a clinically relevant difference (clinically important difference or CID). The purpose of study was to serve as an introduction for hand therapists to responsiveness designs and indices and to highlight their application within the clinical setting. The study design used was a narrative review. Method papers and research studies addressing responsiveness were selected and summarized. Currently, several good studies of responsiveness have been conducted. However, there is a need to move beyond the calculation of standardized change indices to include the calculation of clinically meaningful values. For many of the assessments used in hand clinics, there is still a call for investigation of the amount of change, which exceeds error estimates (MDC) and the amount of change shown to make a clinically relevant difference (CID).