The Smallest Worthwhile Effect as an Alternative to MCID for Adult Scoliosis.

Marc Swiontkowski

MD, FAOA

Professor, University of Minnesota

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Mohit Bhandari

FRCSC, PhD

Distinguished University Professor, Chair of Surgery, McMaster University

The episode opens with reflections on early mornings, coffee rituals, and fall sports before shifting to a detailed discussion on patient-reported outcome measures. The hosts examine a new study introducing the “smallest worthwhile effect” (SWE) as an alternative to traditional MCID thresholds in adult idiopathic scoliosis surgery. They outline how SWE incorporates patient-anchored benefits, risks, and costs, contrasting this with anchor-based and distribution-based MCID methods and highlighting the challenges of interpreting group-level thresholds for individual patients. The conversation broadens into methodological rigor, sample-size limitations, and the growing complexity of statistical modeling in orthopaedic research, emphasizing the importance of expert review, balanced editorial decisions, and the evolution of evidence-based practice across decades.