Estimating Clinically Important Change in Gait Speed in People With Stroke Undergoing Outpatient Rehabilitation

2011 ◽  
Vol 35 (2) ◽  
pp. 82-89 ◽  
Author(s):  
George D. Fulk ◽  
Miriam Ludwig ◽  
Kari Dunning ◽  
Sue Golden ◽  
Pierce Boyne ◽  
...  
Keyword(s):  
Gait Speed ◽  
Important Change ◽  
Outpatient Rehabilitation ◽  
Clinically Important Change

scholarly journals Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

2018 ◽  
Vol 20 (5) ◽  
pp. 238-243
Author(s):  
Prudence Plummer ◽  
Corinne J. Bohling ◽  
L. Ellese Nickles ◽  
Alexis A. Williams ◽  
Amy Thomas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Dual Task ◽  
Gait Speed ◽  
Gait Training ◽  
Important Change ◽  
Relapsing Remitting ◽  
History Of ◽  
Task Conditions ◽  
Clinically Important Change

Abstract Background: Dalfampridine extended release (D-ER) improves gait speed in some people with multiple sclerosis (MS), but many patients who take D-ER demonstrate only small improvements of questionable clinical significance. Physical therapy (PT) may augment the treatment effects of D-ER on the nervous system and improve clinical outcomes. This case report describes the successful use of D-ER combined with multicomponent PT in a patient who did not have a clinically important change in gait speed with D-ER alone. Methods: A 59-year-old woman with a 6-year history of relapsing-remitting MS was prescribed D-ER by her neurologist. After 3 weeks of D-ER therapy (10 mg twice daily), she demonstrated only a 7.1% improvement in the Timed 25-Foot Walk test. She then commenced PT consisting of two 40-minute sessions per week for 6 weeks while continuing D-ER therapy. Training focused on gait, balance, coordination, functional strengthening, and dual-task performance. Results: After 6 weeks of D-ER + PT, she had a further 14.6% improvement in Timed 25-Foot Walk gait speed, for a total improvement of 20.7%, which elevated her above the clinically meaningful threshold of 20%. Similar patterns of improvement were also observed for self-selected gait speed in single- and dual-task conditions. Improvements in fast and dual-task gait speed were retained 3 weeks later. Conclusions: For this patient, combining PT with D-ER therapy improved gait speed more than the use of D-ER alone. Further investigation of D-ER + PT or PT as an alternative to D-ER in patients with submeaningful medication response is warranted.

scholarly journals Determining Meaningful Changes in Gait Speed After Hip Fracture

2006 ◽  
Vol 86 (6) ◽  
pp. 809-816 ◽  
Author(s):  
Kerstin M Palombaro ◽  
Rebecca L Craik ◽  
Kathleen K Mangione ◽  
James D Tomlinson
Keyword(s):  
Hip Fracture ◽  
Expert Opinion ◽  
Roc Curve ◽  
Gait Speed ◽  
Operating Characteristic ◽  
Important Change ◽  
Minimal Detectable Change ◽  
Older Subjects ◽  
Clinically Important Change ◽  
Clinical Expert

AbstractBackground and Purpose. Older subjects after hip fracture walk more slowly than age-matched peers. The extent to which they walk more slowly is difficult to define because the standard error of the measure (SEM), sensitivity to change, and clinically important change have not been reported for gait speed. The purposes of this study were to quantify the SEM for habitual and fast gait speeds among older subjects after hip fracture, to define the minimal detectable change (MDC), and to estimate the minimal clinically important difference (MCID) for habitual gait speed. Subjects. A sample of 92 subjects after hip fracture was drawn from 3 studies that collected gait speed data. Methods. An estimate of the MDC was determined by use of the SEM. The MCID was determined from expert opinion and from a receiver operating characteristic (ROC) curve. Results. The SEM and the MDC were 0.08 m/s and 0.10 m/s for habitual speed and fast speed, respectively. Both methods of MCID estimation identified 0.10 m/s as a meaningful change in habitual gait speed. Discussion and Conclusion. The estimated MCID for gait speed of 0.10 m/s was supported by clinical expert opinion and the cutoff point of the ROC curve. [Palombaro KM, Craik RL, Mangione KK, Tomlinson JD. Determining meaningful changes in gait speed after hip fracture.Phys Ther. 2006; 86:809–816.]

scholarly journals What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

2016 ◽  
Vol 474 (12) ◽  
pp. 2672-2681 ◽  
Author(s):  
Brian C. Werner ◽  
Brenda Chang ◽  
Joseph T. Nguyen ◽  
David M. Dines ◽  
Lawrence V. Gulotta
Keyword(s):  
Shoulder Arthroplasty ◽  
Important Change ◽  
Clinically Important Change

scholarly journals Minimal Clinically Important Change of the Neck Disability Index and the Numerical Rating Scale for Patients With Neck Pain

Spine ◽  
2007 ◽  
Vol 32 (26) ◽  
pp. 3047-3051 ◽  
Author(s):  
Jan J. M. Pool ◽  
Raymond W. J. G. Ostelo ◽  
Jan L. Hoving ◽  
Lex M. Bouter ◽  
Henrica C. W. de Vet
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Important Change ◽  
Numerical Rating ◽  
Neck Disability ◽  
Clinically Important Change

Responsiveness and Minimal Clinically Important Change in Overactive Bladder Symptom Score

Urology ◽  
2011 ◽  
Vol 78 (4) ◽  
pp. 768-773 ◽  
Author(s):  
Momokazu Gotoh ◽  
Yukio Homma ◽  
Osamu Yokoyama ◽  
Osamu Nishizawa
Keyword(s):  
Overactive Bladder ◽  
Symptom Score ◽  
Important Change ◽  
Bladder Symptom ◽  
Clinically Important Change ◽  
Overactive Bladder Symptom Score

scholarly journals Minimal clinically important change in the Toronto Western Spasmodic Torticollis Rating Scale

2018 ◽  
Vol 52 ◽  
pp. 94-97 ◽  
Author(s):  
Alberto J. Espay ◽  
Richard Trosch ◽  
Gustavo Suarez ◽  
Jonathan Johnson ◽  
Dominic Marchese ◽  
...  
Keyword(s):  
Rating Scale ◽  
Important Change ◽  
Spasmodic Torticollis ◽  
Clinically Important Change

Responsiveness and longitudinal validity of the Persian version of COMI to physiotherapy in patients with non-specific chronic low back pain

2020 ◽  
Vol 20 (3) ◽  
pp. 483-490
Author(s):  
Shiva Komesh ◽  
Noureddin Nakhostin Ansari ◽  
Soofia Naghdi ◽  
Parisa Alaei ◽  
Scott Hasson ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Area Under The Curve ◽  
Important Change ◽  
Global Rating ◽  
Low Back ◽  
Operating Characteristics ◽  
Smallest Detectable Change ◽  
Clinically Important Change ◽  
Longitudinal Validity

AbstractBackground and aimsThe Core Outcome Measures Index (COMI) is a short, self-reported questionnaire for assessing important outcomes in patients with low back pain (LBP). The present study was conducted to explore the responsiveness and longitudinal validity of the Persian COMI (COMI-P) in patients with non-specific chronic LBP.MethodsIn this prospective cohort study of patients with non-specific chronic LBP receiving physiotherapy, patients completed a booklet containing the COMI-P, Persian Functional Rating Index (FRI-P), and a visual analogue scale (VAS) for pain before and after the end of ten-sessions of physiotherapy. Patients also completed a global rating of change scale (GRCS) at the end of the physiotherapy. Responsiveness was examined by means of internal responsiveness methods [t-test, standard effect size (SES); standardized response mean (SRM), and Guyatt responsiveness index (GRI)] and external responsiveness methods [correlation with external criteria and receiver operating characteristics (ROC) curve].ResultsFifty patients with a mean age of 50.62 ± 13.8 years participated. The paired t-test showed significant changes in COMI-P scores (p < 0.001). The effect sizes for COMI-P were large (range 0.96–1.23). The score changes for the COMI-P revealed significant correlations with FRI-P (r = 0.67, p < 0.001), the VAS (r = 0.65, p < 0.001), and the GRCS (r = 0.34, p = 0.02). The COMI-P change scores showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (r = 0.83, p < 0.001). The ROC area under the curve for the COMI-P based on the dichotomized SDC criterion was perfect. The minimal clinically important change was estimated 2.15 points (sensitivity 94% and specificity 100%).ConclusionsThe COMI-P appears to have responsiveness and longitudinal validity in detecting changes after physiotherapy for non-specific chronic LBP. An improvement of 2.15 points in COMI-P total score is required to be interpreted as minimally clinically important change in individual patients.

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