Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA 90089, USA.
Phys Ther. 2010 Feb;90(2):196-208. doi: 10.2522/ptj.20090079. Epub 2009 Dec 18.
When people with stroke recover gait speed, they report improved function and reduced disability. However, the minimal amount of change in gait speed that is clinically meaningful and associated with an important difference in function for people poststroke has not been determined.
The purpose of this study was to determine the minimal clinically important difference (MCID) for comfortable gait speed (CGS) associated with an improvement in the modified Rankin Scale (mRS) score for people between 20 to 60 days poststroke.
This was a prospective, longitudinal, cohort study.
The participants in this study were 283 people with first-time stroke prospectively enrolled in the ongoing Locomotor Experience Applied Post Stroke (LEAPS) multi-site randomized clinical trial. Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke. Improvement of >or=1 on the mRS was used to detect meaningful change in disability level.
Mean (SD) CGS was 0.18 (0.16) m/s at 20 days and 0.39 (0.22) m/s at 60 days poststroke. Among all participants, 47.3% experienced an improvement in disability level >or=1. The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS.
Because the mRS is not a gait-specific measure of disability, the estimated MCID for CGS was only 73.9% sensitive and 57.0% specific for detecting improvement in mRS scores.
We estimate that the MCID for gait speed among patients with subacute stroke and severe gait speed impairments is 0.16 m/s. Patients with subacute stroke who increase gait speed >or=0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not. Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke.
当脑卒中患者的步行速度恢复时，他们报告功能得到改善，残疾程度降低。然而，尚未确定脑卒中后患者步行速度的临床最小有意义变化量，以及与功能的重要差异相关的变化量。
本研究旨在确定与脑卒中后 20 至 60 天改良 Rankin 量表（mRS）评分改善相关的舒适步行速度（CGS）的最小临床有意义差异（MCID）。
这是一项前瞻性、纵向、队列研究。
这项研究的参与者是 283 名首次脑卒中的患者，他们前瞻性地参加了正在进行的 Locomotor Experience Applied Post Stroke（LEAPS）多中心随机临床试验。在脑卒中后 20 天和 60 天测量舒适步行速度并获得 mRS 评分。mRS 评分改善>1 被用于检测残疾水平的有意义变化。
平均（标准差）CGS 分别为 20 天 0.18（0.16）m/s 和 60 天 0.39（0.22）m/s。所有参与者中，47.3%的人残疾水平改善>1。将 MCID 估计为 CGS 提高 0.16 m/s，以 mRS 为锚定点。
由于 mRS 不是残疾的特定步态测量指标，因此 CGS 的估计 MCID 对 mRS 评分改善的敏感性为 73.9%，特异性为 57.0%。
我们估计，亚急性脑卒中且严重步态速度受损患者的步态速度 MCID 为 0.16 m/s。与未达到该速度的患者相比，步态速度提高>0.16 m/s 的亚急性脑卒中患者更有可能经历残疾水平的显著改善。临床医生可以使用这个参考值为亚急性脑卒中患者制定目标并解释进展情况。
