Estimating the Minimal Clinically Important Difference of an Upper Extremity Recovery Measure in Subacute Stroke Patients

Abstract

Background: The minimal clinically important difference (MCID) estimates of some of the stroke-related measures are available; but MCID of the Fugl-Meyer assessment (FMA) measure is unknown, which limits the application and interpretation of change scores in poststroke patients with motor deficits. Objective: To estimate the MCID of the FMA-UE (upper extremity) using the modified Rankin scale (mRS) and global rating of patient-perceived changes (GRPPC) in subacute poststroke patients. Methods: The prospective, cohort study took place in the neurology department of a university hospital. Seventy-one subacute poststroke (mean duration, 8.42 weeks) patients were prospectively enrolled in a randomized clinical trial of the ongoing Meaningful Task Specific Training (MTST). FMA-UE, mRS, and GRPPC scores were obtained at pre- and 4 weeks postintervention. Results: The MCID values of FMA-UE were 9 (80.39% sensitive and 70% specific) and 10 (97.62% sensitive and 89.66% specific) anchored to mRS and GRPPC, respectively. Conclusions: The estimated MCID score for the upper extremity motor recovery among patients with subacute stroke is 9 to 10 on the FMA-UE. Patients with subacute stroke who achieve a score of 9 to 10 on FMA-UE are more likely to experience or perceive a meaningful and clinically important improvement in their disability level than those who do not. The reference value can be used to develop goals and interpret progress in subacute poststroke patients.