Article

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. OBJECTIVE: 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. DESIGN:
This was a prospective, longitudinal, cohort study. METHODS: 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. 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 >or=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 >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.

Langue : ANGLAIS