Determining Meaningful Changes in Gait Speed After Hip Fracture

Abstract

Background 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.]

Physical Function and Disability After Acute Care and Critical Illness Hospitalizations in a Prospective Cohort of Older Adults

“…[30][31][32][33] This decline in gait speed after critical illness of 0.16 m/s represents a substantial and meaningful change in gait speed, because the minimum clinically important difference for this measure is 0.1 m/s. [34][35][36][37] Not only was gait slower after critical illness, but subjects were also much less likely to be able to perform the walk and timed chairstand tests after hospitalization. This striking finding indirectly but powerfully demonstrates significant functional impairment.…”

Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review

“…Figure 2 summarizes the yield of the search process. Of 62 articles identified as potentially relevant by the database and hand searches or recommendations by the expert, seven were ultimately included in our summary [21][22][23][24][25][26][27]. Table 2 summarizes the studies.…”

Reproducibility of the Physiological Cost Index among Individuals with a Lower‐Limb Amputation and Healthy Adults

“…There are several slightly different statistical methods that can be used to obtain the SDC (de Vet et al, 2006) and the terminology differs. Examples of other expressions of SDC that occur in the literature include Limits of Agreement, Minimal Detectable Change, Repeatability and Measurement Error (Bland and Altman, 1986;Bland and Altman, 2003;de Vet et al, 2006;Palombaro et al, 2006;Morinder et al, 2009). They all represent the same concept, namely the size of change needed, with 95% confi dence, to exceed the noise of the measurement at a repeated test.…”