Original articleEstimating Minimal Clinically Important Differences of Upper-Extremity Measures Early After Stroke
Section snippets
Participants
Fifty-two subjects with hemiparesis poststroke were enrolled in this study (table 1). Hemiparetic subjects were participating in the VECTORS study, a single-center randomized controlled trial investigating early motor recovery of the upper extremity after stroke conducted at the Washington University School of Medicine. Subjects were recruited via the Cognitive Rehabilitation Research Group Stroke Registry from the acute neurology service of Barnes Jewish Hospital and from the rehabilitation
Results
Fifty-two subjects with hemiparesis poststroke were included in this report (see table 1). Subjects were an average of 64±14 years old and had been largely independent prior to the stroke. The first evaluations occurred an average of 9.5 days poststroke (study day 0), and the second evaluations occurred an average of 25.9 days poststroke (study day 14). The sample had a greater proportion of women than men and was 58% nonwhite. Seventy-nine percent of subjects had ischemic strokes, and 56% of
Discussion
Our purpose was to begin to examine how much change constitutes a clinically meaningful difference on upper-extremity assessments early after stroke. Using subjects' global ratings of upper-extremity change, we attempted to estimate MCID values for 2 impairment level measures, 3 activity level measures, and 2 participation level measures during the first month poststroke (see table 3). Estimates of MCID ranged from 16% to 30% of the total scales. For a few measures, we were unable to estimate
Conclusions
Our data provide some of the first estimates of what constitutes a clinically meaningful change on standardized upper-extremity measures early after stroke. Proportional changes of 16% to 30% were considered important to the people in our study. Care should be taken when attempting to generalize these results to people with chronic stroke or to people in other rehabilitation settings. Future studies with larger sample sizes are needed to refine our estimates and to determine how MCID values are
Acknowledgments
We thank Joanne Wagner, PT, PhD, ATC, and Lily Hu, MS, for their assistance with data collection and the therapists who assisted with recruitment and scheduling during this project.
References (48)
- et al.
Issues in selecting outcome measures to assess functional recovery after stroke
NeuroRx
(2006) - et al.
Measurement of health status: ascertaining the minimal clinically important difference
Control Clin Trials
(1989) - et al.
Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness
J Clin Epidemiol
(2002) - et al.
Determination of the minimal clinically important difference in the FIM instrument in patients with stroke
Arch Phys Med Rehabil
(2006) - et al.
Measurement of upper-extremity function early after stroke: properties of the action research arm test
Arch Phys Med Rehabil
(2006) - et al.
Four methods of estimating the minimal important difference score were compared to establish a clinically significant change in headache impact test
J Clin Epidemiol
(2006) - et al.
The intra- and interrater reliability of the Action Research Arm Test: a practical test of upper extremity function in patients with stroke
Arch Phys Med Rehabil
(2001) - et al.
Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients
Exp Neurol
(1989) - et al.
The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke
Arch Phys Med Rehabil
(2001) - et al.
Ambulatory monitoring of arm movement using accelerometry: an objective measure of upper-extremity rehabilitation in persons with chronic stroke
Arch Phys Med Rehabil
(2005)
Defining post-stroke recovery: implications for design and interpretation of drug trials
Neuropharmacology
Outcome and time course of recovery in stroke, part II: time course of recoveryThe Copenhagen Stroke Study
Arch Phys Med Rehabil
Determining a minimal important change in a disease-specific quality of life questionnaire
J Clin Epidemiol
Physical rehabilitation outcome measures
Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change
Health Qual Life Outcomes
Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research
Curr Opin Rheumatol
The concept of clinically meaningful difference in health-related quality-of-life research: how meaningful is it?
Pharmacoeconomics
Establishing the minimal clinically important difference of the Barthel Index in stroke patients
Neurorehabil Neural Repair
Management patterns and costs of acute ischemic stroke: an international study
Stroke
Costs of stroke care according to handicap levels and stroke subtypes
Cerebrovasc Dis
Identifying meaningful intra-individual change standards for health-related quality of life measures
J Eval Clin Pract
Interpreting clinically significant changes in patient-reported outcomes
Cancer
Validation of a short orientation-memory-concentration test of cognitive impairment
Am J Psychiatry
Very Early Constraint Therapy for Recovery from Stroke (VECTORS): phase II trial results [abstract]
Stroke
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Supported by the National Institutes of Health (grant nos. NS41261, HD047669), and the James S. McDonnell Foundation (grant no. 21002032).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.