Minimal clinically important difference of the Berg Balance Scale and comfortable walking speed in patients with acute stroke: A multicenter, prospective, longitudinal study

Abstract

Objective To determine the minimal clinically important difference between the Berg Balance Scale and comfortable walking speed in acute-phase stroke patients. Design Multicenter, prospective, longitudinal study. Setting Inpatient acute stroke rehabilitation. Subjects Seventy-five patients with acute stroke, mean (SD) age 71.7 (12.2) years. Intervention Inpatients with acute stroke were assessed with the Berg Balance Scale and comfortable walking speed before and after rehabilitation. Physiotherapy was conducted to improve balance and gait over a 2-week period: an average of 40 min/day on weekdays and 20 min/day on weekends and holidays. Main measures The patients’ Berg Balance Scale, comfortable walking speed, Global Rating of Change scale (patient-rated and physiotherapist-rated), and motor score of the Functional Independence Measure were obtained. Minimal clinically important differences were estimated using both anchor- (receiver operating characteristic curves and change difference) and distribution-based approaches (minimal detectable change and 0.5× the change score [SD]). Results The baseline scores were 31.2 (18.9) for the Berg Balance Scale and 0.79 (0.35) m/s for comfortable walking speed. The minimal clinically important difference in the Berg Balance Scale was 6.5–12.5 points by the anchor-based approach and 2.3–4.9 points by the distribution-based approach. The minimal clinically important difference in comfortable walking speed was 0.18–0.25 m/s by the anchor-based and 0.13–0.15 m/s by the distribution-based approach. Conclusions A change of 6.5–12.5 points in the Berg Balance Scale and 0.18–0.25 m/s in the comfortable walking speed is required in these measurements’ anchor-based minimal clinically important differences to be beyond measurement error, and to be perceptible by both patients and clinicians.

The Minimal Clinically Important Difference Changes Greatly Based on the Different Calculation Methods: Letter to the Editor

“…We have observed that our data (although not PRO based) can be used to calculate the MCID of the Berg Balance Scale (BBS) as an external anchor for subjective improvement in balance function among stroke patients. 5 In that study, the MCID ROC was 12.5 points, the MCID Pred was 8.6 points, the MCID Adj was 8.3 points, and the difference was 1.5-fold. This difference in MCID values is smaller than the minimum detectable change (MDC) in the BBS.…”

Minimal detectable change of gait and balance measures in older neurological patients: estimating the standard error of the measurement from before-after rehabilitation data thanks to the linear mixed-effects models

“…A recent study [ 49 ] calculated the MDC and the MCID of comfortable walking speed in stroke patients, the former being 0.13 m/s and the latter 0.18–0.25 m/s. Notably, the gait speed MDC that was found was comparable to the MDC found by [ 49 ] and, most importantly, lower than their MCID.…”

Minimal Clinically Important Difference (MCID) in the Functional Status Measures in Patients with Stroke: Inverse Probability Treatment Weighting

“…In one retrospective clinical analysis of 80 early subacute stroke patients, the estimated MCID of BBS scores was 5 points in the assisted-walking group and 4 points in the unassisted-walking group [ 33 ]. Another prospective assessment of 75 inpatients with acute stroke found the MCID in the BBS to be between 6.5 and 12.5 points, determined via the anchor-based approach [ 34 ]. Furthermore, these values were lower than the MCID values obtained in the present study.…”