Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease Determinants of physical performance in ambulatory patients on hemodialysis. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. What is a Clinically Meaningful Improvement in Leg-Extensor Power for Mobility-limited Older Adults? Test-Retest Reliability and Minimal Detectable Change Scores for the Timed “Up & Go” Test, the Six-Minute Walk Test, and Gait Speed in People With Alzheimer Disease Minimally important clinical difference of the Timed 25-Foot Walk Test: results from a randomized controlled trial in patients with multiple sclerosis Transcranial direct current stimulation associated with gait training in Parkinson’s disease: A pilot randomized clinical trial Meaningful change and responsiveness in common physical performance measures in older adults. Time dependency of walking classification in stroke. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot. Minimal clinically important differences of 3 patient-rated outcomes instruments. Physical performance measures in the clinical setting. Short-distance walking speed tests in people with Parkinson disease: reliability, responsiveness, and validity.
Background 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 clinical ly meaningful and associated with an important difference in function for people poststroke has not been determined . Objective The purpose of this study was to determine the minimal clinical ly 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 . Design This was a prospect i ve , longitudinal , cohort study . Methods The participants in this study were 283 people with first-time stroke prospect ively enrolled in the ongoing Locomotor Experience Applied Post Stroke ( LEAPS ) multi-site r and omized clinical trial . Comfortable gait speed was measured and mRS scores were obtained at 20 and 60 days poststroke . Improvement of ≥1 on the mRS was used to detect meaningful change in disability level . Results 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 ≥1 . The MCID was estimated as an improvement in CGS of 0.16 m/s anchored to the mRS . Limitations 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 . Conclusions 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 ≥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 OBJECTIVE To estimate the minimal clinical ly important difference ( MCID ) for the 6-minute walk test ( 6MWT ) and the 200-m fast-walk test ( FWT ) in patients with coronary artery disease ( CAD ) during a cardiac rehabilitation program . DESIGN Prospect i ve study using distribution- and anchor-based methods . SETTING Out patients from a cardiac rehabilitation unit . PARTICIPANTS Stable patients with CAD ( N=81 ; 77 men ; mean±SD age , 58.1±8.7y ) enrolled 31±12.1 days after an acute coronary syndrome ( ACS ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions . Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances . RESULTS Mean change in 6MWT distance ( 6MWD ) in patients who reported no change was -6.5 m versus 23.3 m in those who believed their performance had improved ( P<.001 ) . This result was consistent with the MCID determined by using the distribution method ( 23 m ) . Considering a 25-m cutoff , positive and negative predictive values were 0.9 and .63 , respectively . Conversely , there was no difference in 200-m FWT performance between these 2 groups ( 0.1 vs -1.4s , respectively ) . There was poor agreement with the physiotherapist 's perceived change . CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25 m . This result will help physicians interpret 6MWD change and help research ers estimate sample sizes in further studies using 6MWD as an endpoint Background Reliability of quantitative gait assessment while dual-tasking ( walking while doing a secondary task such as talking ) in people with cognitive impairment is unknown . Dual-tasking gait assessment is becoming highly important for mobility research with older adults since better reflects their performance in the basic activities of daily living . Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment ( MCI ) under single and dual-task conditions . Methods The gait performance of 11 elderly individuals with MCI was evaluated using an  electronic walkway ( GAITRite ® System ) in two sessions , one week apart . Six gait parameters ( gait velocity , step length , stride length , step time , stride time , and double support time ) were assessed under two conditions : single-task ( sG : usual walking ) and dual-task ( dG : counting backwards from 100 while walking ) . Test-retest reliability was determined using intra-class correlation coefficient ( ICC ) . Gait variability was measured using coefficient of variation ( CoV ) . Results Eleven participants ( average age = 76.6 years , SD = 7.3 ) were assessed . They were high functioning ( Clinical Dementia Rating Score = 0.5 ) with a mean Mini-Mental Status Exam ( MMSE ) score of 28 ( SD = 1.56 ) , and a mean Montreal Cognitive Assessment ( MoCA ) score of 22.8 ( SD = 1.23 ) . Under dual-task conditions , mean gait velocity ( GV ) decreased significantly ( sGV = 119.11 ± 20.20 cm/s ; dGV = 110.88 ± 19.76 cm/s ; p = 0.005 ) . Additionally , under dual-task conditions , higher gait variability was found on stride time , step time , and double support time . Test-retest reliability was high ( ICC>0.85 ) for the six parameters evaluated under both conditions . Conclusion In older people with MCI  , variability of time-related gait parameters increased with dual-tasking suggesting cognitive control of gait performance . Assessment of quantitative gait variables using an electronic walkway is highly reliable under single and dual-task conditions . The presence of cognitive impairment did not preclude performance of dual-tasking in our sample supporting that this methodology can be reliably used in cognitive impaired older individuals We estimated minimal clinical ly important differences ( MCIDs ) for small , moderate , and large changes in measures obtained from a st and ardized treadmill test , a 6-minute walk test , and patient-based outcomes following supervised and home-based exercise programs in symptomatic patients with peripheral artery disease ( PAD ) . Patients were r and omized to either 12 weeks of a supervised exercise program ( n=60 ) , a home-based exercise program ( n=60 ) , or an attention-control group ( n=60 ) . Using the distribution-based method to determine MCIDs , the MCIDs for small , moderate , and large changes in peak walking time ( PWT ) in the supervised exercise group were 38 , 95 , and 152 seconds , respectively , and the changes in claudication onset time ( COT ) were 35 , 87 , and 138 seconds . Similar MCID scores were noted for the home-based exercise group . An anchor-based method to determine MCIDs yielded similar patterns of small , moderate , and large change scores in PWT and COT , but values were 1–2 minutes longer than the distribution approach . In conclusion , 3 months of supervised and home-based exercise programs for symptomatic patients with PAD results in distribution-based MCID small , moderate , and large changes ranging from 0.5 and 2.5 minutes for PWT and COT . An anchor-based approach yields higher MCID values , ranging from a minimum of 73 seconds for COT to a maximum of 4 minutes for PWT . The clinical implication is that a goal for eliciting MCIDs in symptomatic PAD patients through a walking exercise intervention is to increase PWT and COT by up to 4 minutes , which corresponds to two work stages during the st and ardized progressive treadmill test BACKGROUND Physical performance measures , particularly  gait speed  , have been useful as predictors of loss of independence , institutionalization , and mortality in older nonuremic individuals .  Gait speed has not been evaluated as a predictor of these important outcomes in patients on hemodialysis , nor have the determinants of gait speed in the dialysis population been studied . METHODS We performed a cross-sectional analysis to determine whether demographic , clinical , or nutritional status variables were related to physical performance in a group of 46 hemodialysis patients treated at three University of California San Francisco-affiliated dialysis units . Three physical performance measures were examined , including  gait speed , time to climb stairs , and time to rise from a chair five times in succession . Forward stepwise linear-regression analysis was performed with each physical performance measure as the dependent variable and the following c and i date predictor variables : age , gender , body mass index , dialysis vintage , Kt/V , albumin , blood urea nitrogen , creatinine , hematocrit , lean body mass , phase angle , ferritin , and the following comorbidities : hypertension , diabetes mellitus , coronary artery disease , peripheral vascular disease , and cerebrovascular disease . RESULTS Subjects included 31 men and 15 women aged 22 to 87 years ( mean + /- SD , 52 + /- 17 ) . The mean gait speed for the group was 113.1 + /- 34.5 cm/s ( low compared with norms established for persons of similar age ) . Results of multivariable regression showed that age , albumin , and Kt/V were important determinants of gait speed in this population . Overall , the model explained 52 % of the variability in gait speed ( r = 0.72 , P < 0.0001 ) . Qualitatively similar results were obtained using stair-climbing time or chair-rising time as the dependent variables , except that comorbidity was more important than age for stair climbing . The addition of physical activity level to the models did not eliminate the associations of albumin or Kt/V with physical performance . CONCLUSIONS Physical performance is significantly impaired in ambulatory hemodialysis patients and is related to age , serum albumin , and dialysis dose . Prospect i ve studies are needed to determine whether modification of dialysis dose or nutritional interventions can improve physical performance in patients on hemodialysis STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To establish the major clinical ly important improvement ( MCII ) of the timed up- and -go test ( TUG ) , 40-meter self-paced walk test ( 40-m SPWT ) , 30-second chair st and ( 30 CST ) , and a 20-cm step test in patients with hip osteoarthritis ( OA ) undergoing physiotherapy treatment . As a secondary aim , a comparison of methods was employed to evaluate the effect of method on the reported MCII . BACKGROUND Minimal clinical ly important difference scores are commonly used by rehabilitation professionals to determine patient response following treatment . A gold st and ard for calculating MCII has yet to be determined , which has result ed in problems of interpretation due to varied results . METHODS As part of a r and omized controlled trial , 65 patients were r and omized into a physiotherapy treatment group for hip OA , in which they completed 4 physical performance measures at baseline and 9 weeks . Upon completion of physiotherapy , patients assessed their response to treatment on a 15-point global rating of change scale ( GRCS ) . MCII was estimated using 3 variations of an anchor-based method , based on the patient 's opinion . RESULTS A comparison of 3 methods result ed in the following change scores being best associated with our definition of MCII : a reduction equal to or greater than 0.8 , 1.4 , and 1.2 seconds for the TUG ; an increase equal to or greater than 0.2 , 0.3 , and 0.2 m/s for the 40-m SPWT ; an increase equal to or greater than 2.0 , 2.6 , and 2.1 repetitions for the 30 CST ; an increase equal to or greater than 5.0 , 12.8 , and 16.4 steps for the 20-cm step test . CONCLUSION The variation in methods provided very different results . This illustrates the importance of comparing method ologies and reporting a range of values associated with the MCII , as such values vary , depending upon the methodology chosen BACKGROUND Muscle power is a key predictor of physical function in older adults ; however , clinical ly meaningful improvements in leg-extensor muscle power have yet to be identified . The purpose of this study is to establish the minimal clinical ly important improvement ( MCII ) and substantial improvement ( SI ) for leg-extensor power and muscle contraction velocity in mobility-limited older adults . METHODS Data were extracted from three r and omized trials of leg-extensor muscle power training interventions ( 3- to 6-month duration ) .  Measurements of leg-extensor power and velocity were obtained using dynamic bilateral leg press at 40 % and 70 % of the one-repetition maximum . Anchor-based MCIIs were calculated using selected items extracted from the Late Life Function and Disability Instrument . St and ard error of measurement and effect size methods were used to calculate the distribution-based MCII . RESULTS Data from 164 participants ( mean age : 76.6 ± 5.6 years ; Short Physical Performance Battery score : 7.8 ± 1.3 ) were used in this analysis . The respective MCII and SI estimates for 40 % leg-extensor power were 18.3 ( 9 % ) and 30.5 ( 15 % ) W , and 23.1 ( 10 % ) and 41.6 ( 18 % ) W for 70 % leg-extensor power . The respective MCII and SI estimates for 40 % average velocity were 0.03(7 % ) and 0.08(18 % ) m/s , and 0.02(6 % ) and 0.05(15 % ) m/s for 70 % average velocity . CONCLUSIONS This is the first study to establish a clinical ly meaningful improvement of leg-extensor power ( 9%-10 % ) and velocity ( 6%-7 % ) in mobility-limited older adults . These findings should be used to aid in the design and interpretation of clinical trials and interventions that target improvements in muscle power in this high-risk population Background : With the increasing incidence of Alzheimer disease ( AD ) , determining the validity and reliability of outcome measures for people with this disease is necessary . Objective : The goals of this study were to assess test-retest reliability of data for the Timed “ Up & Go ” Test ( TUG ) , the  Six-Minute Walk Test  ( 6MWT ) , and gait speed and to calculate minimal detectable change ( MDC ) scores for each outcome measure . Performance differences between groups with mild to moderate AD and moderately severe to severe AD ( as determined by the Functional Assessment Staging [ FAST ] scale ) were studied . Design : This was a prospect i ve , nonexperimental , descriptive method ological study . Methods : Background data collected for 51 people with AD included : use of an assistive device , Mini-Mental Status Examination scores , and FAST scale scores . Each participant engaged in 2 test sessions , separated by a 30- to 60-minute rest period , which included 2 TUG trials , 1 6MWT trial , and 2 gait speed trials using a computerized gait assessment system . A specific cuing protocol was followed to achieve optimal performance during test sessions . Results : Test-retest reliability values for the TUG , the 6MWT , and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately ( intraclass correlation coefficients ≥.973 ) ; however , individual variability of performance also was high . Calculated MDC scores at the 90 % confidence interval were : TUG=4.09 seconds , 6MWT=33.5 m ( 110 ft ) , and gait speed=9.4 cm/s . The 2 groups were significantly different in performance of clinical tests , with the participants who were more cognitively impaired being more physically and functionally impaired . Limitations : A single research er for data collection limited sample numbers and prohibited blinding to dementia level . Conclusions : The TUG , the 6MWT , and gait speed are reliable outcome measures for use with people with AD , recognizing that individual variability of performance is high . Minimal detectable change scores at the 90 % confidence interval can be used to assess change in performance over time and the impact of treatment Abstract Background : Limited data define what constitutes a clinical ly significant change on the Timed 25-Foot Walk ( T25FW ) in multiple sclerosis ( MS ) ; however , most studies suggest a value of ≥20 % . Analyses were undertaken to estimate the minimally important clinical difference ( MICD ) in walking speed as measured by the T25FW in patients with MS . Methods : Data from MS-F203 , a r and omized trial of dalfampridine extended release tablets , 10 mg twice daily ( prolonged-release/sustained-release fampridine outside the US ) in patients with MS , were used to calculate the MICD , as an absolute and percentage value , for the T25FW test . Both anchor- ( using the Clinician Global Impression [ CGI ] ) and distribution-based ( 2.77 × st and ard error of measurement or 0.50 st and ard deviation units ) approaches were used . Using the anchor-based estimations , the proportion of patients in the dalfampridine and placebo groups achieving at least a MICD in MS-F203 was determined . Results : A correlation between change in T25FW speed during and CGI at the end of double-blind period was found ( Spearman r = −0.39 , p < 0.0001 ) . Irrespective of treatment group , participants categorized ‘ minimally improved ’ by the CGI had a mean improvement in T25FW speed of 0.36 feet/second or a 17.2 % relative change from an average baseline walking speed of 2.1 feet/second ( effect size = 0.49 ) ; values representing MICDs . MICD estimates of 0.35 and 0.37 feet/second were generated using distribution-based approaches . In MS-F203 , a greater proportion of patients receiving dalfampridine achieved ≥0.36 feet/second ( 12/72 vs. 78/224 , p = 0.007 ) and a 17.2 % ( 11/72 vs. 87/224 , p = 0.0005 ) improvement in T25FW speed compared to placebo . Limitations : MICD estimates from this analysis may not apply to patients with different disease characteristics from MS-F203 . A different anchor may result in a different MICD estimation . Conclusion : Our MICD estimate for an improvement in T25FW is close to previous estimates of 20 % change . Dalfampridine may improve walking speed in a considerable proportion of patients by a clinical ly relevant amount ABSTRACT Objective : The aim of this study is to investigate the effects of transcranial direct current stimulation ( tDCS ) combined with cueing gait training ( CGT ) on functional mobility in patients with Parkinson´s disease ( PD ) . Methods : A pilot double-blind controlled , r and omized clinical trial was conducted with 22 patients with PD assigned to the experimental ( anodal tDCS plus CGT ) and control  group  ( sham tDCS plus CGT ) . The primary outcome ( functional mobility ) was assessed by 10-m walk test , cadence , stride length , and Timed Up and Go test . Motor impairment , bradykinesia , balance , and quality of life were analyzed as secondary outcomes . Minimal clinical ly important differences ( MCIDs ) were observed when assessing outcome data . Results : Both groups demonstrated similar gains in all outcome measures , except for the stride length . The number of participants who showed MCID was similar between groups . Conclusion : The CGT provided many benefits to functional mobility , motor impairment , bradykinesia , balance , and quality of life . However , these effect magnitudes were not influenced by stimulation , but tDCS seems to prolong the effects of cueing therapy on functional mobility OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change BACKGROUND AND PURPOSE To facilitate optimal stroke rehabilitation , valid interpretation of observed functional recovery is required . The purpose of this study was to examine the longitudinal relationship between comfortable walking speed and  Functional Ambulation Categories ( FAC ) scores for physically independent gait . SUBJECTS This study was a prospect i ve cohort study with 73 subjects who were severely affected by acute stroke . METHODS Functional Ambulation Categories classification and walking speed were measured between weeks 4 and 26 after stroke . The responsiveness of walking speed  measurements for detecting clinical ly important speed changes was determined , and the longitudinal association between walking speed and FAC scores and its time dependency were established . This relationship subsequently was scrutinized for possible speed changes occurring within specific FAC scores . Responsiveness ratios , r and om coefficient analysis , paired Student t tests , and the Cohen kappa statistic were used for statistical analyses . RESULTS Responsiveness ratios exceeded the smallest detectable differences . R and om coefficient analysis demonstrated a significant between- and within-subject coefficient and a significant negative interaction between timing of measurements and FAC scores . Paired Student t tests revealed mostly significant pretest-posttest differences in walking speeds , and all kappa values for pretest-posttest FAC scores were significant . DISCUSSION AND CONCLUSION Walking speed measurements are sensitive for detecting clinical ly important changes . Functional Ambulation Categories scores are dependent on the timing of comfortable walking speed measurements after stroke . Moreover , there are indications that , in this relationship , repeated FAC appraisal s are not only based on steady walking speeds , but that the walking speeds related to a specific FAC appraisal also change and , over time , may shift gradually from higher to lower speeds OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke OBJECTIVE To describe changes in and predictors of comfortable gait speed ( GS-C ) after using a foot-drop stimulator ( FDS ; Bioness L300 ; Bioness Inc , Valencia , CA ) for 42 weeks in persons who had sustained a stroke . DESIGN Secondary analysis of prospect i ve assessment s. SETTING Multicenter clinical trial . PARTICIPANTS A total of 99 subjects who had sustained a stroke ≥ 3 months earlier and who had GS-C ≤ 0.8 m/s and drop foot with a mean age of 60.7 years and a poststroke time of 4.8 years . METHODS GS-C was assessed at baseline and at 30 weeks with and without use of an FDS ( therapeutic effect ) and at 6 , 12 , 30 , 36 , and 42 weeks with use of an FDS ( total effect ) . After subjects participated in 8 physical therapy sessions , an FDS was used for ambulation over the course of 42 weeks . MAIN OUTCOME MEASUREMENTS Changes in mean GS-C over time , FDS " responder " status defined as either ≥ 0.1 m/s gain in GS-C ( the minimal clinical ly important difference [ MCID ] ) or advancing by one Perry Ambulation Category ( PAC ) , and the incidence and nature of adverse events ( AEs ) . RESULTS A total of 74 ( 75 % ) and 69 ( 70 % ) of 99 subjects completed assessment s at 30 weeks and 42 weeks , respectively . Baseline GS-C was 0.42 m/s without use of an FDS and 0.49 m/s with use of an FDS . GS-C improved to 0.54 m/s at 30 weeks without use of an FDS ( effect size = 0.75 ) and 0.54 , 0.55 , 0.58 , 0.60 , and 0.61 m/s at 6 , 12 , 30 , 36 , and 42 weeks with use of an FDS , respectively ( effect size 0.84 at 42 weeks ) . Half of the subjects achieved a maximum GS-C by 12 weeks . Approximately 18 % were PAC responders and 29 % were MCID responders for 30-week therapeutic effect , and 55 % were PAC responders and 67 % were MCID responders for 42-week total effect . After logistic regression , the following factors emerged as the strongest predictors of FDS responders : younger age , faster baseline GS-C and Timed Up and Go , and balance . At 42 weeks , 60 % reported a device-related AE ; 92 % were mild and 96 % were anticipated . CONCLUSIONS When an FDS was used , GS-C improved progressively over 42 weeks , with ≥ 50 % of patients achieving a clinical ly meaningful 42-week total effect and 50 % achieving a maximum GS-C by 12 weeks . Younger patients with greater mobility levels may benefit most from use of an FDS . AEs were frequent , mild , and reversible PURPOSE Patient-rated instruments are increasingly used to measure orthopedic outcomes . However , the clinical relevance of modest score changes on such instruments is often unclear . This study was design ed to define the minimal clinical ly important differences ( MCIDs ) of the Disabilities of the Arm , Shoulder , and H and ( DASH ) , QuickDASH ( subset of DASH ) , and Patient-Rated Wrist Evaluation ( PRWE ) question naires for atraumatic conditions of the h and , wrist , and forearm . METHODS We prospect ively analyzed 102 patients undergoing nonoperative treatment for isolated tendinitis , arthritis , or nerve compression syndromes from the forearm to the h and . By phone , patients completed the DASH , QuickDASH , and PRWE at enrollment and at 2 weeks ( n = 78 used in the analysis ) and 4 weeks ( n = 24 used in the analysis ) after initiating treatment . Patients reporting clinical improvement each contributed a single data point categorized as no change ( n = 41 ) , minimal improvement ( n = 30 ) , or marked improvement ( n = 31 ) via a vali date d anchor-based approach . We calculated the MCID as the mean change score for each outcome measure in the minimal improvement group . RESULTS The MCID ( 95 % confidence interval ) for the DASH was 10 ( 5 - 15 ) . The MCID for the QuickDASH was 14 ( 9 - 20 ) . The MCID was 14 ( 8 - 20 ) for the PRWE . The MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement . The MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores . CONCLUSIONS Longitudinal changes on the DASH of 10 points , on the QuickDASH of 14 points , and on the PRWE of 14 points represent minimal clinical ly important changes . We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients . These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures . TYPE OF STUDY /LEVEL OF EVIDENCE Diagnostic III OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting PURPOSE The aims of this study were to determine test-retest reliability and responsiveness of short-distance walking speed tests for persons with Parkinson disease ( PD ) . Discriminant and convergent validity of walking speed tests were also examined . METHODS Eighty-eight participants with PD ( mean age , 66 years ) with mild to moderate severity ( stages 1 - 4 on the Hoehn and Yahr Scale ) were tested on medications . Measures of activity included the  comfortable and fast 10-m walk tests ( CWT , FWT ) , 6-min walk test ( 6MWT ) , mini balance evaluations systems test ( mini-BEST Test ) , fear of falling ( FoF ) , and the Activity-Specific Balance Confidence Scale ( ABC ) . The mobility subsection of the PD quality of life-39 ( PDQ39-M ) served as a participation-based measure . RESULTS Test-retest reliability was high for both walking speed measures ( CWT , ICC(2,1 ) = 0.98 ; FWT , ICC(2,1 ) = 0.99 ) . Minimal detectable change ( MDC(95 ) ) for the CWT and FWT was 0.09 m/s and 0.13 m/s respectively . Participants at Hoehn & Yahr levels 3/4 demonstrated significantly slower walking speed with the CWT and FWT than participants at Hoehn & Yahr levels 1 and 2 ( P < .01 ) . The CWT and FWT were both significantly ( P ≤ .002 ) correlated with all activity and participation-based measures . CONCLUSIONS Short-distance walking speed tests are clinical ly useful measures for persons with PD . The CWT and FWT are highly reliable and responsive to change in persons with PD . Short distance walking speed can be used to discriminate differences in gait function between persons with mild and moderate PD severity . The CWT and FWT had moderate to strong associations with other activity and participation based measures demonstrating convergent validity
Changes in gait speed of 0.10 to 0.20 m s(-1 ) may be important across multiple patient groups
RATIONALE , AIMS AND OBJECTIVES Walking speed is an important performance variable , but information on the minimal clinical ly important difference ( MCID ) for the measure has not been consoli date d. In this review , we aim ed to summarize information on the MCID for change in comfortable gait speed measurements for patients with pathology .