Article

The Functional Gait Assessment (FGA) is commonly used to measure
walking balance. The minimal clinically important difference (MCID) has yet to be
determined for the FGA. The purposes of this study were to determine:
(1) the MCID in the FGA for older community-dwelling adults relative to patients'
and physical therapists' estimates of change and (2) the extent of agreement
between patients' and physical therapists' estimates of change. This
study was a prospective case series. METHODS: Patients and physical therapists
rated the amount of change in balance while walking after an episode of physical
therapy for balance retraining on a 15-point global rating of change (GROC)
scale. Weighted kappa statistics were calculated to express agreement between
patients' and physical therapists' GROC ratings. Functional Gait Assessment
change scores were plotted on receiver operating characteristic curves. A cutoff
of +3 on the GROC was the criterion used for important change. The optimal FGA
change cutoff score for MCID was determined, and sensitivity (SN), specificity
(SP), and likelihood ratios (LRs) were calculated. RESULTS: One hundred
thirty-five community-dwelling older adults (average age=78.8 years) and 14
physical therapists participated. There was poor agreement between the patients'
and therapists' ratings of change (weighted kappa=.163). The estimated MCID value
for the FGA using physical therapists' ratings of change as an anchor was 4
points (SN=0.66, SP=0.84, LR+=4.07, LR-=0.40). No accurate value for the FGA MCID
could be determined based on the patients' ratings of change. LIMITATIONS: The
small sample size was a limitation. CONCLUSION: Poor agreement between
therapists' and patients' ratings indicate the need for further communication
relative to patient goals. The 4-point MCID value for the FGA can be used for
goal setting, tracking patient progress, and program evaluation.
CI - (c) 2014 American Physical Therapy Association.

Langue : ANGLAIS