Defining the Minimal Clinically Important Difference of the PainDETECT Questionnaire: Implications for Personalized Pain Management After Total Knee Arthroplasty

Xiaofeng Chang; Shuxin Yao; Zhao Yang; Lei Shang; Chao Xu; Jianbing Ma

doi:10.1016/j.arth.2025.06.046

Defining the Minimal Clinically Important Difference of the PainDETECT Questionnaire: Implications for Personalized Pain Management After Total Knee Arthroplasty

J Arthroplasty. 2025 Jun 18:S0883-5403(25)00752-1. doi: 10.1016/j.arth.2025.06.046. Online ahead of print.

Authors

Xiaofeng Chang¹, Shuxin Yao², Zhao Yang³, Lei Shang⁴, Chao Xu⁵, Jianbing Ma⁶

Affiliations

¹ Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 E.Youyi Rd, Xi'an, 710061, China; Xi'an medical university, No. 1, Xinwang Rd, Weiyang District, Xi 'an, 710021, China. Electronic address: 15929400555@163.com.
² Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 E.Youyi Rd, Xi'an, 710061, China. Electronic address: yaoshuxinHHH@126.com.
³ Department of orthopaedics, The First Affiliated Hospital of Air Force Military Medical University, No.127 W. Changle Rd, Xi'an,710032, China. Electronic address: yangzhaofirst@126.com.
⁴ Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, No.169 W. Changle Rd, Xi'an, 710032, China. Electronic address: fmmushanglei@163.com.
⁵ Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 E.Youyi Rd, Xi'an, 710061, China; Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, No.169 W. Changle Rd, Xi'an, 710032, China. Electronic address: 383697196@qq.com.
⁶ Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 E.Youyi Rd, Xi'an, 710061, China. Electronic address: drmajianbing@163.com.

PMID: 40541850
DOI: 10.1016/j.arth.2025.06.046

Abstract

Background: The PainDETECT Questionnaire (PDQ) is a validated tool for identifying neuropathic pain (NeP) and assessing postoperative pain. However, its minimal clinically important difference (MCID) remains undefined, particularly in Chinese patients undergoing total knee arthroplasty (TKA). This study aimed to determine the MCID for the PDQ in patients who have NeP and nociceptive pain (NP) after TKA and evaluate its correlation with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Five - Level EuroQoL Group's Five - Dimension Questionnaire (EQ - 5D - 5L), and Central Sensitization Inventory-Chinese Version (CSI-CV).

Methods: In this prospective cohort study, 625 patients undergoing unilateral TKA were assessed preoperatively and at 1-year postoperatively using PDQ, WOMAC, EQ-5D-5L, and CSI-CV. The minimal clinically important difference (MCID) for the PDQ was calculated using anchor-based, distribution-based, and receiver operating characteristic (ROC) curve methods.

Results: The MCID was higher in the NeP group than in the NP group. The anchor-based MCID was 5.0 [95% CI (confidence interval), 4.3 to 5.6] in NeP and 3.0 [95% CI, 2.9 to 3.2] in NP, while the distribution-based method yielded 4.4 and 2.6, respectively. The ROC cutoff identified MCID thresholds of 4.0 points in NeP (Area Under the Curve (AUC), 0.98; P < 0.001) and 2.5 points in NP (AUC, 0.94; P < 0.001). In NeP, PDQ changes correlated strongly with WOMAC (r = 0.75), EQ-5D-5L (r = 0.67), and CSI-CV (r = 0.74) (P < 0.05). In NP, correlations were moderate for WOMAC (r = 0.45), EQ-5D-5L (r = 0.56), and CSI-CV (r = 0.24) (P < 0.05).

Conclusion: The MCID for the PDQ score of patients who had Nep after TKA was greater than that for patients who did not have Nep. This study provides evidence-based MCID values for the PDQ in Chinese TKA patients, supporting its use in personalized pre- and postoperative pain management.

Keywords: MCID; PainDETECT; Total knee arthroplasty; neuropathic; nociceptive.