Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients

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.

A Robot-Assisted Therapy to Increase Muscle Strength in Hemiplegic Gait Rehabilitation

“…MCID is defined as "the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient's management" (Jaeschke et al, 1989). This concept is common in the clinic and some studies have analyzed it in post-stroke gait for different joints in the sagittal plane such as the hip, where the MCID of the ROM for the affected side is about 5.81 • and for the unaffected side at around 2.86 • (Guzik et al, 2021), and the knee, where MCID of the ROM for the affected side is about 8.48 • and for the unaffected side at around 6.81 • (Guzik et al, 2020). Although PROM is related to the ROM studied in Guzik et al (2020Guzik et al ( , 2021, it is usually higher and no specific MCID was found for this population and measured in the literature.…”

“…This concept is common in the clinic and some studies have analyzed it in post-stroke gait for different joints in the sagittal plane such as the hip, where the MCID of the ROM for the affected side is about 5.81 • and for the unaffected side at around 2.86 • (Guzik et al, 2021), and the knee, where MCID of the ROM for the affected side is about 8.48 • and for the unaffected side at around 6.81 • (Guzik et al, 2020). Although PROM is related to the ROM studied in Guzik et al (2020Guzik et al ( , 2021, it is usually higher and no specific MCID was found for this population and measured in the literature. Neither was it found for lower limb joint strength.…”

Test-Retest Reliability of Kinematic and Temporal Outcome Measures for Clinical Gait and Stair Walking Tests, Based on Wearable Inertial Sensors

“…The test battery in the current study is commonly used for evaluation of gait function in neurological patients and was extended to include a wearable inertial sensor system for a more thorough gait analysis. The kinematic and temporal outcome measures can be used to evaluate, e.g., gait asymmetry and reduced range of motion, which are important aspects of walking ability post-stroke [ 7 , 8 , 9 , 10 , 11 , 12 ]. However, the current study was based on a control group with normal walking ability, and the results needs to be verified in patients with neurological disorders, such as stroke.…”

“…Kinematic data was then time-normalized over each gait cycle and variables were computed for each gait cycle for the pelvis and thorax segments and for the shoulder, hip, knee, and ankle joints. The variables were selected from kinematic and temporal variables earlier suggested for use in clinical gait analysis [ 26 ] and of interest for post-stroke analyses [ 7 , 8 , 10 , 11 , 12 ]. These variables were the peak flexion angle, peak extension angle, the range of motion (i.e., peak flexion to peak extension, RoM), and the stride frequency (number of gait cycles per second).…”

“…The only outcome measure from all these gait tests is the average walking speed [ 3 ]. This outcome measure has high inter- and intra-rater reliability [ 6 ], but it does not capture the important aspects that explain the resulting gait velocity post-stroke, such as joint kinematics [ 7 , 8 ], stance phase time [ 9 ], temporal side asymmetries [ 10 ], arm swing during gait [ 11 ], or adaptions of gait patterns during fast gait [ 12 ].…”