Houchen-Wolloff Linzy, Boyce Sally, Singh Sally
Centre for Exercise and Rehabilitation Science (CERS), Respiratory Biomedical Research Unit (BRU), University Hospitals of Leicester NHS Trust, UK
Centre for Exercise and Rehabilitation Science (CERS), Respiratory Biomedical Research Unit (BRU), University Hospitals of Leicester NHS Trust, UK.
Eur J Prev Cardiol. 2015 Aug;22(8):972-8. doi: 10.1177/2047487314540840. Epub 2014 Jun 23.
The aim was to establish the minimum clinically important difference (MCID) in the incremental shuttle walk test (ISWT) following cardiac rehabilitation.
This was a service evaluation, utilising anchor- and distribution-based methods.
Two hundred and twenty patients performed an ISWT following a six-week cardiac rehabilitation programme comprising supervised aerobic exercise, secondary prevention education and a home exercise programme.
Patient perception of change in ISWT distance following cardiac rehabilitation. After completing cardiac rehabilitation, subjects were asked to identify, from a five-point Likert scale, their perceived change in exercise performance (range: from 'better' to 'worse'). Two distribution-based methods were also employed (standard deviation (SD) and effect size). The agreement between all measures was observed.
Mean (SD) age was 65.0 (10.5) years, body mass index 28.4 (5.1), 170 male. The baseline ISWT was 390.8 (173.1) metres (m), which increased to 456.0 (186.7) m (mean change 65.2 (95% confidence interval 55.4-74.9) m after cardiac rehabilitation (p < 0.001)). In those rating their exercise tolerance as 'slightly better', the mean improvement was 70.0 (95% confidence interval 51.5-88.5) m. The SD method yielded a minimum clinically important difference value of 36.65 m and the effect size for the change was 0.38. The agreement between the patients' perception of change and distribution-based methods was poor.
The minimum clinically important difference for the ISWT following cardiac rehabilitation is 70 m. This patient-reported value is a more sensitive measure and has poor agreement with distribution-based estimates. This value may help clinicians interpret ISWT change in patients, help researchers estimate sample size and aid comparison between studies, when the ISWT is the primary outcome.
目的是确定心脏康复后递增式往返步行试验（ISWT）中最小临床重要差异（MCID）。
这是一项采用基于锚定和分布方法的服务评估。
220名患者在完成一项为期六周的心脏康复计划后进行了ISWT，该计划包括有监督的有氧运动、二级预防教育和家庭锻炼计划。
患者对心脏康复后ISWT距离变化的感知。完成心脏康复后，受试者被要求从五点李克特量表中确定他们对运动表现的感知变化（范围：从“更好”到“更差”）。还采用了两种基于分布的方法（标准差（SD）和效应量）。观察了所有测量方法之间的一致性。
平均（标准差）年龄为65.0（10.5）岁，体重指数为28.4（5.1），男性170名。基线ISWT为390.8（173.1）米（m），心脏康复后增加到456.0（186.7）m（平均变化65.2（95%置信区间55.4 - 74.9）m，p < 0.001）。那些将运动耐量评为“稍好”的患者，平均改善为70.0（95%置信区间51.5 - 88.5）m。SD方法得出的最小临床重要差异值为36.65 m，变化的效应量为0.38。患者对变化的感知与基于分布的方法之间的一致性较差。
心脏康复后ISWT的最小临床重要差异为70 m。这个患者报告的值是一个更敏感的指标，与基于分布的估计值一致性较差。当ISWT是主要结局时，这个值可能有助于临床医生解释患者的ISWT变化，帮助研究人员估计样本量并有助于研究之间的比较。
