Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference

Author:

Tilson Julie K.1,Sullivan Katherine J.2,Cen Steven Y.3,Rose Dorian K.4,Koradia Cherisha H.5,Azen Stanley P.6,Duncan Pamela W.7,

Affiliation:

1. J.K. Tilson, PT, DPT, NCS, is Assistant Professor of Research Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA 90089 (USA).

2. K.J. Sullivan, PT, PhD, FAHA, is Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, and Associate Chair and Director, Doctor of Physical Therapy Program, University of Southern California.

3. S.Y. Cen, PhD, is Assistant Professor of Research, Division of Biokinesiology and Physical Therapy, University of Southern California.

4. D.K. Rose, PT, PhD, is Research Assistant Professor, Department of Physical Therapy, University of Florida, Gainesville, Florida.

5. C.H. Koradia, PT, is Physical Therapist, First Class Physical Therapy, Brooklyn, NY. At the time of the study, she was an MS student in the Graduate Program in Biokinesiology and Physical Therapy, University of Southern California.

6. S.P. Azen, PhD, is Professor and Co-Director of Biostatistics, Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California.

7. P.W. Duncan, PT, PhD, FAHA, FAPTA, is Professor and Bette Busch Maniscalco Research Fellow, Division of Doctor of Physical Therapy, Department of Community and Family Medicine; Professor, School of Nursing; and Senior Fellow, Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.

Abstract

BackgroundWhen people with stroke recover gait speed, they report improved function and reduced disability. However, the minimal amount of change in gait speed that is clinically meaningful and associated with an important difference in function for people poststroke has not been determined.ObjectiveThe purpose of this study was to determine the minimal clinically important difference (MCID) for comfortable gait speed (CGS) associated with an improvement in the modified Rankin Scale (mRS) score for people between 20 to 60 days poststroke.DesignThis was a prospective, longitudinal, cohort study.MethodsThe participants in this study were 283 people with first-time stroke prospectively enrolled in the ongoing Locomotor Experience Applied Post Stroke (LEAPS) multi-site randomized clinical trial. Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke. Improvement of ≥1 on the mRS was used to detect meaningful change in disability level.ResultsMean (SD) CGS was 0.18 (0.16) m/s at 20 days and 0.39 (0.22) m/s at 60 days poststroke. Among all participants, 47.3% experienced an improvement in disability level ≥1. The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS.LimitationsBecause the mRS is not a gait-specific measure of disability, the estimated MCID for CGS was only 73.9% sensitive and 57.0% specific for detecting improvement in mRS scores.ConclusionsWe estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s. Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not. Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke.

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3