Clinically meaningful change in stair negotiation performance in older adults

Stair negotiation is a key marker for independence among older adults; however, clinically meaningful change has not been established. Our objective was to establish the values of clinically meaningful change in stair negotiation time using distribution- and anchor-based approaches. Study participants were 371 community residing older adults (age≥70) in the Einstein Aging Study with time to ascend and descend 3 steps measured at baseline and at one-year follow-up. Anchor-based estimates were obtained using functional decline (defined as one-point increment in disability score) and change in self-reported walking ability over the one-year follow-up period. Small, moderate, and large meaningful change estimates were 0.28, 0.71, and 1.15 s for stair ascent time (0.31, 0.78, and 1.25 s for stair descent time) using the distribution-based approach of effect size. The estimates of meaningful decline range from 0.47 to 0.53 s for stair ascent time (0.33-0.53 s for stair descent time) using the anchor-based approach. The estimates of meaningful improvement were smaller (0.13-0.18 s for stair ascent, 0.06-0.15 for stair descent) compared to those for decline. Based on general consistency between distribution- and anchor-based approaches, preliminary criteria suggested for stair negotiation time is 0.5 s for meaningful decline and 0.2 s for meaningful improvement.