Abstract
The importance of knee sagittal kinematic parameters, as a predictor of walking performance in post-stroke gait has been emphasised by numerous researchers. However, no studies so far were designed to determine the minimal clinically important differences (MCID), i.e., the smallest difference in the relevant score for the kinematic gait parameters, which are perceived as beneficial for patients with stroke. Studies focusing on clinically important difference are useful because they can identify the clinical relevance of changes in the scores. The purpose of the study was to estimate the MCID for knee range of motion (ROM) in the sagittal plane for the affected and unaffected side at a chronic stage post-stroke. Fifty individuals were identified in a database of a rehabilitation clinic. We estimated MCID values using: an anchor-based method, distribution-based method, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. In the anchor-based study, the mean change in knee flexion/extension ROM for the affected/unaffected side in the MCID group amounted to 8.48°/6.81° (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 1.86°/5.63° (the second MCID estimate). Method 3 analyses showed 7.71°/4.66° change in the ROM corresponding to 1.85-point change in the Barthel Index. The best cut-off point, determined with ROC curve, was the value corresponding to 3.9°/3.8° of change in the knee sagittal ROM for the affected/unaffected side (the fourth MCID estimate). We have determined that, in chronic stroke, MCID estimates of knee sagittal ROM for the affected side amount to 8.48° and for the unaffected side to 6.81°. These findings will assist clinicians and researchers in interpreting the significance of changes observed in kinematic sagittal plane parameters of the knee. The data are part of the following clinical trial: Australian New Zealand Clinical Trials Registry: ACTRN12617000436370
Highlights
Measurement of progress in rehabilitation is of utmost importance
The mean change in knee flexion/extension range of motion (ROM) for the affected side was 8.48◦, which constituted the first estimate of the minimal clinically important difference (MCID) of the knee flexion/extension ROM for the affected side (Table 4)
Our findings provide the first estimates of MCID of the knee sagittal ROM for individuals with hemiparesis after stroke
Summary
Measurement of progress in rehabilitation is of utmost importance. For post-stroke rehabilitation, there are numerous standardised clinical measures predominantly assessing temporal and spatial gait parameters, e.g., 10-m walk test [1,2], 2-, 6-, and 12-min walk tests [2,3], up and go test [4], cadence [5] or step length symmetry [6]. The concept of minimal clinically important difference (MCID) is currently at the centre of a newer approach in research on clinical measures post-stroke [7]. The values of MCID have already been determined for the above measures [9,10,11]. No studies have aimed to determine the MCID for kinematic gait parameters post-stroke, even though kinematic analysis of gait provides objective evidence and may successfully be used to evaluate effects of gait re-education [12]
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