Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke

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

Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study

“…5.7° [ 65 ]) and the minimal clinically important difference for knee sagittal range of motion in stroke survivors (i.e. 8.48° [ 66 ]). As improved post-stroke knee kinematics may promote safe foot clearance [ 12 ], it might be interesting for future studies to investigate intervention effects on both propulsion and knee kinematics in a larger group of stroke survivors with reduced knee flexion during swing at baseline.…”

Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta‐analysis and systematic review

“…This finding is in line with the results reported by both Chai et al and Deng et al 7,8 Since the MCID of the ROM following KA has not been reported in previous literature, it may be premature to draw conclusions regarding whether the addition of corticosteroids to LIA enhances functional recovery of the knee. Recently, researchers have attempted to estimate the MCID for the ROM post‐stroke; their MCID estimates of the knee sagittal ROM were 8.48°and 6.81° for the affected and unaffected knees, respectively 43 . Because of the differences in baseline measures between the knee after stroke and the knee after arthroplasty, the statistically significant change observed on postoperative day 1 (MD = 9.14) may not be one that matters to the patient.…”

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

“…MCID is defined as "the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate (...) a change in the patient's management" (16). So far, MCID has been calculated for only one of the above major 3DGA kinematic predictors of walking performance post-stroke, i.e., for knee (17). In addition to that, some related studies have aimed to determine the minimal detectable change (MDC) in individuals post-stroke (18,19).…”

“…This study is the second part of a broader research project. The first part aimed 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 ( 17 ). Taking into consideration the aforementioned facts, we have decided to continue the related research, this time focusing on the kinematic parameter of hip sagittal ROM, in line with the evidence suggesting the high reliability of 3DGA ( 12 ).…”

“…From clinical practitioners' viewpoint, the MCID is highly useful since it enables the evaluation of effects achieved by patients receiving therapy; it may also provide effective support in the process of designing treatment strategies ( 17 , 28 ). Given the above, the current study aimed to establish MCID values for hip ROM in the sagittal plane, i.e., flexion–extension (FE) for the affected and unaffected sides in patients with chronic stroke.…”