Applying concepts of responsiveness to patient management in neurologic physical therapy

Determining whether real change has taken place as a result of treatment and whether that change constitutes important change are challenges central to evidence-based physical therapist practice. Recently, the literature reporting these values for clinical measures has expanded considerably. In this article, we discuss some of the indices for identifying real change and important change, and how physical therapists can use these indices to enhance the interpretability of change scores derived from clinical measures. Specifically, we define and discuss the uses of the minimal detectable change and the minimal clinically important difference. We provide suggestions for how these indices can be used to make change scores more meaningful to therapists, patients, their caregivers, and third-party payers. Accurate interpretation and application of these indices are crucial to informed patient management and clinical decision making. We also present some of the limitations confronted as we try to apply these values across various patient diagnostic groups and across the spectrum of initial level of impairment. Finally, recommendations are made for directions for future research in this important area of outcomes research and how clinicians can contribute to these efforts.