Background

The minimal clinically important difference (MCID) of modified Dynamic Gait Index (mDGI) has not yet been determined for People with Neurological Disorders (PwND).

Research question

To establish the MCID of the mDGI to determine clinically meaningful improvement in balance and gait in PwND.

Methods

In this longitudinal study from a randomised clinical trial, 55 participants both in and outpatients with neurological disorders, received fifteen 40-minute rehabilitation sessions. Inpatients received daily treatments over a period of three weeks while outpatients received three treatments/week over a period of five weeks. An anchor-based method using percentage rating of improvement in balance (Activities Balance Confidence scale, ABC) was used to determine the MCID of mDGI. The MCID was defined as the minimum change in mDGI total score (post – pre intervention) that was needed to perceive at least a 10 % improvement on the ABC scale. A Receiver Operating Characteristic curve was used to define the cut-off for the optimal MCID of the mDGI discriminating between improved and not improved participants.

Results

The MCID of the mDGI total score was 6 points and Area under the Curve was 0.64. For the mDGI time sub-scores the MCID was 2 points and Area under the Curve was 0.6.

Significance

The MCID of balance and gait improvement measured by mDGI was prudently establish at ≥7 points, meaning that this is the minimum improvement score PwND need to get to perceive a clinically relevant change in their balance and gait confidence. These reference values can be a tool incorporated into clinicians daily practice to interpret mDGI change scores helping to determine whether the intervention is effective; to develop clinical tailored intervention goals and to establish meaningful perceived change in PwND.

中文翻译：

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修正动态步态指数在神经系统疾病患者中的最小临床重要差异

背景

尚未确定神经系统疾病患者 (PwND) 的修正动态步态指数 (mDGI) 的最小临床重要差异 (MCID)。

研究问题

建立 mDGI 的 MCID，以确定 PwND 平衡和步态的临床意义改善。

方法

在这项随机临床试验的纵向研究中，55 名神经系统疾病患者和门诊患者接受了 15 次 40 分钟的康复治疗。住院患者在三周内每天接受治疗，而门诊患者在五周内每周接受三次治疗。使用平衡改善百分比评级（活动平衡信心量表，ABC）的基于锚的方法用于确定 mDGI 的 MCID。MCID 被定义为在 ABC 量表上感知至少 10% 的改善所需的 mDGI 总分（干预后 - 干预前）的最小变化。接收者操作特征曲线用于定义区分改善和未改善参与者的 mDGI 的最佳 MCID 的截止值。

结果

mDGI总分的MCID为6分，曲线下面积为0.64。对于 mDGI 时间子分数，MCID 为 2 分，曲线下面积为 0.6。

意义

由 mDGI 测量的平衡和步态改善的 MCID 谨慎地建立在≥7 分，这意味着这是 PwND 需要获得的最低改善分数，以感知其平衡和步态信心的临床相关变化。这些参考值可以成为临床医生日常实践中的一种工具，用于解释 mDGI 变化评分，帮助确定干预是否有效；制定临床定制的干预目标，并在 PwND 中建立有意义的感知变化。