Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Difference of the Nottingham Extended Activities of Daily Living Scale in Patients With Improved Performance After Stroke Rehabilitation

Wu, Ching‐yi; Chuang, Li-Ling; Lin, Keh‐chung; Lee, Shin-Da; Hong, Wei-Hsien

doi:10.1016/j.apmr.2011.03.008

Cited by 64 publications

(51 citation statements)

References 52 publications

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“…Changes exceeding the MDC represent the amount by which a subject's measure needs to change to be sure the change is greater than measurement error. 7,33,35 Our data show that the MDC is 20% or greater of the respective mean value for each position tested. As such, individual subject changes after intervention are not likely to exceed the MDC in many cases.…”

Section: Within-day Reliabilitymentioning

confidence: 55%

“…7 The MDC is an estimate of the smallest amount of change between separate measures that can be detected objectively as true change outside of the measurement error. 7,33,35 This calculation helps clinical decision making as to whether the change score in individual performance represents real change. 4,35 The MDC 90 is frequently used when the outcomes aid decisions regarding effectiveness of an intervention.…”

Section: Discussionmentioning

confidence: 99%

“…7,33,35 This calculation helps clinical decision making as to whether the change score in individual performance represents real change. 4,35 The MDC 90 is frequently used when the outcomes aid decisions regarding effectiveness of an intervention.…”

Section: Discussionmentioning

confidence: 99%

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Reliability and Minimal Detectable Change of 3-Dimensional Scapular Orientation in Individuals With and Without Shoulder Impingement

Haik

Alburquerque‐Sendín²,

Camargo³

2014

J Orthop Sports Phys Ther

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Scapulothoracic movement results from a complex interaction of sternoclavicular and acromioclavicular joint motion. 12,21 There is evidence that alterations of this motion pattern are associated with shoulder pathologies, such as shoulder impingement and rotator cuff disease. 20,22,23,25 However, there are some inconsistencies and discrepancies regarding scapular orientation alterations across studies. 22Electromagnetic devices are commonly used to measure 3-D scapular orientation during shoulder movements in healthy subjects and individuals with different shoulder conditions. [19][20][21][23][24][25]31,37,38 The use of a skin-based sensor attached to the scapula has previously been shown to be a valid method to measure scapular orientation and motion when compared to a bone-based technique.14 Despite the wide use of surface sensors to assess 3-D scapular orientation in different shoulder conditions, limited data are available concerning reliability of these methods.Only 1 study 32 has specifically evaluated the reliability of measurement of scapular orientation and showed that the within-day was better than the betweenday reliability in young, healthy subjects. The authors 32 also recommended the use of arm elevation in the sagittal plane when the most repeatable scapular pattern is desired. Although Thigpen et al 32 have contributed to the literature, their results cannot be generalized, as they only evaluated healthy subjects and elevation of the arm. It is also important to measure scapular orientation in people with shoulder dysfunction and when lowering the arm. Most importantly, a number of recent studies have investigated the efficacy of therapeutic interventions by making kinematic evaluations of subjects on different days without a clear knowledge of between-day reliability. 10,24,34 Better documentation of the reliability of 3-D T T STUDY DESIGN: Clinical measurement. T T OBJECTIVE:To establish trial-to-trial within-day and between-day reliability, standard error of measurement, and minimal detectable change of scapular orientation during elevation and lowering of the arm, and with the arm relaxed at the side, in individuals with and without shoulder impingement. T T BACKGROUND:Electromagnetic devices are commonly used to measure 3-D scapular kinematics during arm elevation in different conditions and for intervention studies. However, there is a lack of studies that evaluate within-and between-day reliability of these measurements. T T METHODS:The subjects were allocated to either a control group or an impingement group. Kinematic data were collected using the Flock of Birds electromagnetic device during elevation and lowering of the arm in the sagittal plane on 2 different occasions, separated by 3 to 5 days. Forty-nine subjects were tested for within-day reliability. Forty-three subjects were reassessed for between-day reliability. T T RESULTS:Intraclass correlation coefficients for within-and between-day assessment of scapular orientation during elevation and lowering of the arm in both groups ran...

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Section: Within-day Reliabilitymentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Reliability and Minimal Detectable Change of 3-Dimensional Scapular Orientation in Individuals With and Without Shoulder Impingement

Haik

Alburquerque‐Sendín²,

Camargo³

2014

J Orthop Sports Phys Ther

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“…(337)NEAS is found to be reasonably reliable and feasible in elderly patients. (267,270,339) It is validated for hip replacement patients, but not for fracture patients. We believe that the similarity between fracture and replacement patients is acceptable for using NEAS as a measure of i-ADL.…”

Section: Outcomes and Follow-upmentioning

confidence: 99%

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

et al. 2015

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Bakgrunn: Hoftebrudd er en viktig årsak til sykdom og død med 1.3 millioner brudd årlig i verden og en fortsatt stigende insidens. Risikofaktorer er høy alder, osteoporose og skrøpelighet, og de fleste bruddene skyldes lav energitraumer på grunn av fall. Høy alder, nedsatt funksjon før bruddet og mannlig kjønn øker risiko for et uheldig resultat, mens fall utendørs er prognostisk gunstig.Utvikling av såkalt ortogeriatriske behandlingsmodeller for hoftebrudd som bruker teknikker og prinsipper utviklet i geriatrien er en måte å bedre prognosen for pasientene. Det er utviklet flere modeller:1. Konsultasjonsmodeller der pasienten på vanlig måte behandles i en ortopedisk avdeling, men får tilsyn og vurdering av geriater eller et geriatrisk team under oppholdet, og der teamet deretter foreslår tiltak til ortoped. 2. Modeller med felles ansvar der geriater og ortoped inngår i et team som utreder og behandler pasienten og legger en felles plan for videre oppfølging. 3. Geriatrisk team modeller der utredning og behandling (med unntak av selve kirurgien)foregår i en geriatrisk avdeling tilpasset bruddbehandling, og der ortopeder ansvarlig for operasjon, men ellers kun konsulteres ved behov. Målsetninger for studien: Overordnet mål for studien var å undersøke om bred geriatrisk utredning og behandling (CGC) ga en tilleggsgevinst sammenlignet med tradisjonell ortopedisk behandling (OC).Målsetninger for denne avhandlingen er:1. Å beskrive bakgrunn, utvikling og prinsippene bak de orthogeriatriske modellen og hvordan den skiller seg fra vanlig behandling (Artikkel I). 2. Å presentere kliniske resultat (Artikkel II): a. Mobilitet fire måneder etter bruddet (primaert endepunkt) b. Sekundaere endepunkt: i. Mobilitet etter en og 12 måneder, og p-i-ADL, kognisjon, frykt for å falle, stemningsleie og livskvalitet en, fire og 12 måneder etter bruddet, ii. Bruk av helsetjenester første året etter bruddet 3. Finne ut om effekten på mobilitet, p-og-i-ADL og kognisjon var avhengig av alder, kjønn, bruddtype og funksjon før bruddet (Artikkel III).Metode: Hoftebruddsstudien i Trondheim er en randomisert kontrollert studie basert på ortogeriatrimodell 3 ovenfor. Studien sammenligner standard ortopedisk behandling (OC) med ortogeriatrisk behandling i en egen enhet (CGC). Hjemmeboende pasienter 70 år eller eldre som klarer å gå minst 10m og som har et lavenergibrudd kunne inkluderes, mens pasienter fra sykehjem, høy-energi brudd, patologisk fraktur eller annen sykdom med forventede leveutsikter på mindre enn 3 måneder ble ekskludert. Behandlingen er basert på bred geriatrisk utredning (CGA) og gjennomføres av et tverrfaglig team bestående av geriater (overlege eller lege i spesialisering), sykepleier, fysioterapeut og ergoterapeut; teamet har regelmessige møter der det lages individuelle behandlingsplaner og settes mål for opphold og klargjør videre behov etter utreise samt behandlingsmål. Behandlingen er helhetlig og fokuserer på tidlig mobilisering, gjennomgang av den enkelte pasient med tanke på bakenforliggende sykdom, medisingjennomgang...

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“…A study by Wu et al 378 suggested that the minimum clinically significant difference in the total NEADL score is 2.4, so this has been used within the sample size calculation for a future study. Based on a t-test with an alpha value of 5% and 90% power to detect a difference of 2.4 (SD 5.86), 254 participants are required to complete the trial over both treatment groups.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Difference of the Nottingham Extended Activities of Daily Living Scale in Patients With Improved Performance After Stroke Rehabilitation

Cited by 64 publications

References 52 publications

Reliability and Minimal Detectable Change of 3-Dimensional Scapular Orientation in Individuals With and Without Shoulder Impingement

Reliability and Minimal Detectable Change of 3-Dimensional Scapular Orientation in Individuals With and Without Shoulder Impingement

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

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