Minimum Clinically Important Difference of Gross Motor Function and Gait Endurance in Children with Motor Impairment: A Comparison of Distribution-Based Approaches

Abstract

Objective. The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders. Methods. A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals. Results. The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension “D” of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension “E,” MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods. Conclusions. This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.

Decline in Motor Function during the COVID-19 Pandemic Restrictions and Its Recovery in a Child with Cerebral Palsy: A Case Report

“…When physical therapy was subsequently resumed, the patient’s ability to maintain a sitting posture and weight-bearing capacity of the lower extremities were found to have decreased, and the Gross Motor Function Measure (GMFM-88) total score decreased from 34.5% to 31.9% ( Table 2 ). This decline in scores was more pronounced in the standing domain (dimension D) than in the other domains and was higher than the minimum clinically important difference (MCID) value of 5.2%, recently reported by Storm et al [ 12 ]. Specifically, the scores of items 53 to 55, related to the ability to maintain a standing position, decreased.…”

Sibling Umbilical Cord Blood Infusion is Safe in Young Children with Cerebral Palsy

“…15 Minimum clinically important differences (MCIDs) of large effect size have been reported as ranging from 1.2 to 2.7 points for the GMFM-66 among ambulatory children with CP, 16 and it has been suggested that MCIDs may be even lower in more severely affected children. 17 The observed mean GMFM-66 improvement of 4.7 points exceeds this threshold, indicating a clinically significant improvement. Limitations of the study included its small sample size, the lack of a control group, and the single point of follow-up for efficacy (6 months) by the study team.…”

“…The GMFM‐66 is an accepted measure of motor function capability specific to CP and is highly recommended as a motor function outcome for CP research by the National Institute of Neurological Disorders and Stroke 15 . Minimum clinically important differences (MCIDs) of large effect size have been reported as ranging from 1.2 to 2.7 points for the GMFM‐66 among ambulatory children with CP, 16 and it has been suggested that MCIDs may be even lower in more severely affected children 17 . The observed mean GMFM‐66 improvement of 4.7 points exceeds this threshold, indicating a clinically significant improvement.…”

Different Designs of Proximal Femoral Stems for Total Hip Arthroplasty: Mid-Term Clinical and Patient-Reported Functional Outcomes

“…For this cohort of patients, the primary outcomes of interest were failure to achieve the MCID on the HOOS-PS, PROMIS PF-10a, and PROMIS M-10a. A change of PROM score from pre-to post-THA of 9.3 (HOOS-PS), 4.1 (PROMIS PF-10a), and 3.7 (PROMIS M-10a) were determined as the threshold for achieving MCID using the distribution-based method, a validated method that sets the MCID threshold as one-half of the standard deviation of PROM change from preoperative to postoperative states across all patients [16][17][18]. If the difference between the preoperative to postoperative PROM for a patient was higher than the MCID threshold, he or she was classified as having achieved the MCID.…”