Responsiveness of functional assessments to monitor change in balance, walking speed and strength of older adults: A systematic review of the minimal detectable change

Abstract

AbstractObjectivesThe objective of this paper is to systematically review and evaluate the responsiveness of different functional tests via the minimal detectable change (MDC) across different older adult population cohorts.DesignSystematic review of ISI Web of Knowledge and PubMed databases were searched up to September 26th 2020.SettingCommunity dwellings, hospital and residential homesParticipantsStudies were included if participants were adults over the age of 60. This study reports data from studies that utilise healthy community dwelling older adults, as well as older adults who are hospitalised, live in residential home or have musculoskeletal conditions.InterventionsNo interventions feature in this studyPrimary and secondary outcome measuresMDC reported for gait speed, grip strength, balance, timed up and go, and repeated chair stand separated per older adult sub-group were deemed the primary outcome measure. A secondary outcome measure were the results of a regression analysis, performed to determine the effect of the functional test, cohort, study design and MDC calculation methodology on MDC magnitude.ResultsThirty-nine studies met the inclusion criteria. Not all assessments were evaluated in the literature for all population cohorts. The MDC was affected by the functional test used, the cohort and MDC calculation methodology.ConclusionThe MDC can be assessment and population specific, and thus this should be taken into account when using the MDC. It appears acceptable that different assessors are involved in the re-assessment of the same person.Trial registrationThe systematic review protocol was published in PROSPERO (CRD42019147527).Article SummaryStrengths and Limitations of this StudyStrength: A range of assessments were included to determine if MDC could be used to prioritize specific assessments in interventions.Strength: A wide range of search criteria and methods resulting in 6448 studies being assessed that enabled the inclusion of 39 original research papers to derive 138 MDC values.Strength: Analysis of MDC95 for functional tests commonly used by practitioners to assess effective change in older adultsStrength: Analyses of the impact of method design features such as different assessors on the MDCLimitation: Limited to the settings and tests selected