Changes in gait speed of 0.10 to 0.20 m s(-1) may be important across multiple patient groups.

[Purpose] The purpose of this retrospective study was to determine the minimal clinically important difference for comfortable gait speed for patients with stroke. [Subjects] Data were analyzed from 35 patients undergoing inpatient rehabilitation. [Methods] Two characteristics of gait were measured, assistance required and comfortable gait speed. Patients were grouped as either experiencing or not experiencing a decrease of 2 or more levels of assistance required over the course of rehabilitation. Receiver operating characteristic curve analysis was used to identify the change in gait speed that best differentiated between patients who did and did not experience the requisite decrease in assistance required for gait. [Results] Twenty-one patients decreased 2 or more levels of assistance whereas 14 did not. Walking speed increased significantly more in the group who experienced a decrease in assistance of at least 2 levels. The receiver operating characteristic curve analysis showed a change in walking speed of 0.13 m/s best distinguished between patients who did versus did not experience a reduction in assistance required. [Conclusion] An improvement in gait speed of 0.13 m/s or more is clinically important in patients with stroke.

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Evidence is heterogeneous regarding the influence of exercise on cardiovascular disease biomarkers in at-risk patients, which does not allow a definitive conclusion. Favorable effects include reductions in triglycerides, total cholesterol, low-density lipoprotein, glucose, and insulin, and elevation in high-density lipoprotein following exercise intervention. The strongest evidence indicates that exercise is favorable for the reduction in glucose and cholesterol levels among obese patients, and reduction of insulin regardless of population.

BACKGROUND: The responsiveness of measurements obtained by hand-held dynamometry (HHD) is largely unexplored. OBJECTIVE: A secondary analysis of data from a clinical cohort of patients (N = 55) admitted for inpatient rehabilitation following acute stroke was completed to determine the responsiveness of measures of lower extremity muscle strength. METHOD:The isometric strength of hip flexion, knee extension, and ankle dorsiflexion was measured bilaterally in 55 patients using HHD. Independence in bed-to-chair transfers, level ground gait, and stair negotiation was determined using an ordinal mobility scale. All measures were obtained at admission and discharge. RESULTS: Over the course of rehabilitation muscle strength increased significantly (p 0.002) in all 3 lower limb muscle actions of both the weaker and stronger sides. Effect sizes (0.19-0.43) and standardized response means (0.45-0.79) were mostly small to moderate but tended to be greater on the weaker side than the stronger side. The minimum detectable change (95%) values ranged from 33.2 to 87.5 N and were higher on the stronger than on the weaker side. Receiver operating characteristic curve analysis for identifying minimal clinically important differences revealed cut-points between −12.9 and 52.9 Newtons for strength increases differentiating patients who did and did not demonstrate improved mobility. CONCLUSION: HHD is capable of detecting changes in lower limb strength after stroke but the responsiveness, as indicated by effect size, standardized response mean, minimum detectable change and minimal clinically importance is limited.