Fabiola Giovanna Mestanza Mattos, Thomas Bowman, Cristina Allera Longo, Serena Bocini, Michele Gennuso, Francesca Marazzini, Francesco Giuseppe Materazzi, Elisa Pelosin, Martina Putzolu, Silvia Salvalaggio, Andrea Turolla, Susanna Mezzarobba, Davide Cattaneo
{"title":"Establishing minimal clinically important difference of modified dynamic gait index in people with subacute stroke.","authors":"Fabiola Giovanna Mestanza Mattos, Thomas Bowman, Cristina Allera Longo, Serena Bocini, Michele Gennuso, Francesca Marazzini, Francesco Giuseppe Materazzi, Elisa Pelosin, Martina Putzolu, Silvia Salvalaggio, Andrea Turolla, Susanna Mezzarobba, Davide Cattaneo","doi":"10.1080/10749357.2024.2437326","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>People with stroke (PwST) often have significant balance limitations, making it crucial to focus rehabilitation on improving mobility and reducing the risk of falls. The Modified Dynamic Gait Index (MDGI) is recommended for measuring balance in various neurological conditions, but a minimal clinically important difference (MCID) score specific to PwST is missing.</p><p><strong>Objectives: </strong>To calculate the MCID of the MDGI in PwST during the subacute phase.</p><p><strong>Methods: </strong>This study is a secondary analysis utilizing data from an observational longitudinal study. Forty-four PwST met the inclusion criteria such as age > 18 years, diagnosis of cerebral infarction or hemorrhage within 180 days, and Mini-Mental State Examination ≥ 21. Participants received at least 10 sessions of tailored physiotherapy to improve balance and gait. Balance was assessed using the MDGI and the Activities-specific Balance Confidence Scale (ABC) before and after intervention. The MCID was determined using an anchor-based approach, with the ABC serving as the anchor.</p><p><strong>Results: </strong>Statistically significant improvements were observed in mean MDGI change scores of 19.5(14.6) points, (<i>p</i> < 0.01) and ABC change scores of 27.1(25.3) points, (<i>p</i> < 0.01). The MCID for the MDGI total score was identified as 17.5 points. The Spearman correlation between MDGI and ABC change scores was 0.51 (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>An MCID of 17.5 points for the MDGI total score indicates clinically meaningful improvements in balance and gait performance in subacute PwST undergoing rehabilitation. This value provides a robust metric for evaluating the efficacy of balance-related interventions in this population.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-5"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Topics in Stroke Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/10749357.2024.2437326","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
Abstract
Background: People with stroke (PwST) often have significant balance limitations, making it crucial to focus rehabilitation on improving mobility and reducing the risk of falls. The Modified Dynamic Gait Index (MDGI) is recommended for measuring balance in various neurological conditions, but a minimal clinically important difference (MCID) score specific to PwST is missing.
Objectives: To calculate the MCID of the MDGI in PwST during the subacute phase.
Methods: This study is a secondary analysis utilizing data from an observational longitudinal study. Forty-four PwST met the inclusion criteria such as age > 18 years, diagnosis of cerebral infarction or hemorrhage within 180 days, and Mini-Mental State Examination ≥ 21. Participants received at least 10 sessions of tailored physiotherapy to improve balance and gait. Balance was assessed using the MDGI and the Activities-specific Balance Confidence Scale (ABC) before and after intervention. The MCID was determined using an anchor-based approach, with the ABC serving as the anchor.
Results: Statistically significant improvements were observed in mean MDGI change scores of 19.5(14.6) points, (p < 0.01) and ABC change scores of 27.1(25.3) points, (p < 0.01). The MCID for the MDGI total score was identified as 17.5 points. The Spearman correlation between MDGI and ABC change scores was 0.51 (p < 0.01).
Conclusions: An MCID of 17.5 points for the MDGI total score indicates clinically meaningful improvements in balance and gait performance in subacute PwST undergoing rehabilitation. This value provides a robust metric for evaluating the efficacy of balance-related interventions in this population.
背景：卒中患者（PwST）通常有明显的平衡限制，因此将康复重点放在改善活动能力和降低跌倒风险上至关重要。改良动态步态指数（MDGI）被推荐用于测量各种神经系统疾病的平衡，但缺乏针对PwST的最小临床重要差异（MCID）评分。目的：计算PwST亚急性期MDGI的MCID。方法：本研究是利用观察性纵向研究数据的二次分析。44例PwST符合纳入标准，如年龄bb0 ~ 18岁，180天内诊断为脑梗死或出血，迷你精神状态检查≥21。参与者接受了至少10次量身定制的物理治疗，以改善平衡和步态。在干预前后使用MDGI和特定活动平衡信心量表（ABC）评估平衡。MCID采用基于锚点的方法确定，ABC作为锚点。结果：MDGI平均变化评分为19.5分（14.6分），（p p p p）有统计学意义的改善。结论：MDGI总分的MCID为17.5分，表明亚急性PwST接受康复治疗的平衡和步态表现有临床意义的改善。该值为评估与平衡相关的干预措施在该人群中的有效性提供了一个可靠的指标。
期刊介绍：
Topics in Stroke Rehabilitation is the leading journal devoted to the study and dissemination of interdisciplinary, evidence-based, clinical information related to stroke rehabilitation. The journal’s scope covers physical medicine and rehabilitation, neurology, neurorehabilitation, neural engineering and therapeutics, neuropsychology and cognition, optimization of the rehabilitation system, robotics and biomechanics, pain management, nursing, physical therapy, cardiopulmonary fitness, mobility, occupational therapy, speech pathology and communication. There is a particular focus on stroke recovery, improving rehabilitation outcomes, quality of life, activities of daily living, motor control, family and care givers, and community issues.
The journal reviews and reports clinical practices, clinical trials, state-of-the-art concepts, and new developments in stroke research and patient care. Both primary research papers, reviews of existing literature, and invited editorials, are included. Sharply-focused, single-issue topics, and the latest in clinical research, provide in-depth knowledge.
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