Estimating Minimal Clinically Important Differences of Upper-Extremity Measures Early After Stroke

Abstract

Objective-To estimate minimal clinically important difference values of several upper extremity measures early after stroke.Design-Data in this report were collected during the VECTORS trial, an acute, single-blind randomized controlled trial of Constraint Induced Movement Therapy. Subjects were tested at the pre-randomization baseline assessment (average of 9.5 days post stroke), and the first post-treatment assessment (25.9 days post stroke). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based minimal clinically important difference values were calculated separately for the affected dominant upper extremities and the affected non-dominant upper extremities for each of the 6 tests. Setting-Inpatient rehabilitation hospital.Participants-Fifty-two people with hemiparesis post stroke. Results-Minimal clinically important difference values for grip strength were 5.0 and 6.2 kg for the affected dominant and non-dominant sides respectively. Minimal clinically important difference values for the ARAT were 12 and 17 points, for the WMFT Function score were 1.0 and 1.2 points, and for the MAL How well score were 1.0 and 1.1 points for the two sides respectively. Minimal clinically important difference values were indeterminate for the dominant (composite strength), the non-dominant (WMFT Time score) or for both affected sides (duration of use) for the other measures. Interventions-Not applicable. Main Outcome Measures-EstimatedCorresponding Author: Catherine E. Lang, PT, PhD, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park, St. Louis, MO 63108, Fax: 314.286.1410, Office: 314.286.1945 We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work are clearly identified in the title page of the manuscript. NIH Public Access

Reliability and Validity of Two Versions of the Upper Extremity Functional Index

“…12 Our finding is also similar to preliminary pMCID findings reported for selected performance-based UE measures among people with hemiparesis following stroke. 10 Different pMCID values for participants with non-dominant and dominant affected arms support the view that the pMCID value is context-specific. 31 Independent verification of the current findings is recommended in the future.…”

“…10 Briefly, they suggest that limited function may trouble patients more when it affects the dominant limb than when the non-dominant limb is involved, because the dominant arm is used for more skilled movements; therefore, a smaller improvement in ability to use the affected arm may be more significant for the patient. The literature on arm dominance and the pMCID is limited and inconclusive.…”

“…The literature on arm dominance and the pMCID is limited and inconclusive. [10][11][12] The impact of limb dominance on the pMCID has not been determined for the original UEFI or for the UEFI-15.…”

Forced Aerobic Exercise Enhances Motor Recovery After Stroke: A Case Report

“…The participant demonstrated improvement on all motor outcomes and all but one nonmotor outcome at EOT and maintained or improved at EOT14 (Tables 2 and 3). Tables 2 and 3 also display minimal clinically important difference (MCID) and minimal detectable change (MDC; Fulk et al, 2008;Lang, Edwards, Birkenmeier, & Dromerick, 2008;Lin et al, 2009;Page, Fulk, & Boyne, 2012). The participant demonstrated a 20-point improvement on the FMA at EOT, achieving the MCID and MDC at EOT and EOT14.…”

Functional Recovery Following Stroke

“…[63][64][65][66][67] All but one study calculated MCID values from CIMT trials. 63,64,66,67 The other study investigated change following robotic therapy. 65 Four studies 63,[65][66][67] utilized individuals with chronic stroke and one study sample consisted of individuals with acute stroke.…”