Abstract
Many researchers have pointed out that decreased sagittal range of motion (ROM) in the affected hip joint is a common consequence of stroke, and it adversely affects walking performance and walking speed. Nevertheless, the minimal clinically important differences (MCID) in hip-related kinematic gait parameters post-stroke have not yet been determined. The present study aimed to define MCID values for hip ROM in the sagittal plane i.e., flexion–extension (FE), for the affected and unaffected sides at a chronic stage post-stroke. Fifty participants with hemiparesis due to stroke were enrolled for the study. Four statistical methods were used to calculate MCID. According to the anchor-based approach, the mean change in hip FE ROM achieved by the MCID group on the affected/unaffected side amounted to 5.81°/2.86° (the first MCID estimate). The distribution-based analyses established that the standard error of measurement in the no-change group amounted to 1.56°/1.04° (the second MCID estimate). Measurements based on the third method established that a change of 4.09°/0.61° in the hip ROM corresponded to a 1.85-point change in the Barthel Index. The optimum cutoff value, based on ROC curve analysis, corresponded to 2.9/2.6° of change in the hip sagittal ROM for the affected/unaffected side (the fourth MCID estimate). To our knowledge, this is the first study to use a comprehensive set of statistical methods to determine the MCID for hip sagittal ROM for the affected and unaffected sides at a chronic stage post-stroke. According to our findings, the MCID of the hip FE ROM for the affected side amounts to 5.81° and for the unaffected side to 2.86°, in patients with chronic stroke. This indicator is extremely important because it allows clinical practitioners to assess the effects of interventions administered to patients, and to interpret the significance of improvements in sagittal kinematic parameters of the hip; ultimately, it may facilitate the process of designing effective gait reeducation programs.
Highlights
Stroke is the second most common cause of mortality worldwide and the third most frequent cause of disability and premature death [1]
As regards the anchor-based analyses, the findings showed that, at the follow-up, deterioration in the hip FE range of motion (ROM) was not reported by any patients as a result of which only two groups (MCID/positive change and no change) could be distinguished based on the patients’ perceptions of the hip sagittal ROM
The fact that the present study focused on estimation of minimal clinically important differences (MCID) for hip sagittal ROM only is linked with the evidence reported in the related literature, and in a robust systematic review based on 23 studies investigating the reliability of 3DGA kinematic gait measurement, and suggesting that DGA kinematic indices related to the hip and knee in the sagittal plane present the highest reliability, while the lowest reliability and highest error are frequently found in measurements of the hip and knee in the transverse plane [12]
Summary
Stroke is the second most common cause of mortality worldwide and the third most frequent cause of disability and premature death [1]. Impaired gait after stroke leads to the most severe sense of loss since the patient’s return to the society and to their workplace largely depends on the improvement and recovery of walking ability [5]. As established by other researchers, accurate evaluation of gait kinematics enables assessment of improvement in functional abilities achieved by the patient; it is helpful in predicting the outcomes, in planning therapy and monitoring effects of the post-stroke rehabilitation [7,8,9]. Observational gait analysis is the most common approach to evaluating gait kinematics, there are a limited number of diagnostic tools designed for assessing gait patterns in patients with hemiparesis after stroke [8, 10]. Three-dimensional gait analysis (3DGA) today is a golden standard in this area as it provides objective data related to kinematic parameters [11,12,13]
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