Responsiveness and clinically important differences of the Western Ontario Rotator Cuff (WORC) Index in surgical and non-surgical treatment groups with different follow-up periods: A systematic review and meta-analysis

Figures

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  Figure 1.. Flow diagram of study selection process. This figure illustrates the systematic review and meta-analysis screening procedure. Initially, 658 studies were identified from databases and registers. After removing 41 duplicates, 617 titles were screened, leading to the exclusion of 480 studies. The remaining 137 abstracts were reviewed, with 100 excluded based on the abstract content. A full-text review was conducted for 37 studies, out of which 16 were excluded for various reasons: non-English language (n = 5), protocol studies (n = 5), and review articles (n = 6). Ultimately, 21 full-text articles were included in the qualitative synthesis, with nine additional studies excluded for lacking psychometric properties, resulting in 12 studies meeting all eligibility criteria for inclusion.

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  Figure 2.. Responsiveness of WORC in different follow-up durations. Figure 2 presents a graphical representation of the responsiveness of the WORC Index across various follow-up durations. It illustrates the range of MCID values, SRMs, and other relevant metrics observed in different follow-up periods as identified in the systematic review. The data points in the figure show the variability in responsiveness, highlighting the differences between short-term (less than six months) and long-term (more than six months) follow-ups. The trend lines depict the general direction and magnitude of the responsiveness, providing a clear visual understanding of how the WORC's ability to detect clinically meaningful changes varies over time. This figure underscores the importance of considering follow-up duration in interpreting the WORC scores and their clinical implications.

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  Figure 3.. Comparative responsiveness of WORC across different treatment methods. Figure 3 visually represents the comparative responsiveness of the WORC Index across different treatment modalities. It displays the MCID values, SRMs, and other pertinent metrics for various treatment types, including surgical and conservative approaches. The figure highlights the variability in WORC responsiveness, delineating the differences in how effectively the WORC detects clinically meaningful changes in patients undergoing different types of treatments. The trends and data points in the figure provide a clear visual representation of the WORC's performance in diverse therapeutic contexts, emphasizing the critical role of the treatment type in interpreting WORC scores and their clinical significance.