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Published on: January 12, 2019
Minimum Clinically Important Difference of Gross Motor Function and Gait Endurance in Children with Motor Impairment:
Fabio Alexander Storm1, Maurizio Petrarca2, Elena Beretta3
1Scientific Institute, IRCCS "E. Medea", Bioengineering Laboratory, Bosisio Parini, Lecco, Italy.
Insights
This study establishes minimum clinically important difference (MCID) ranges for the 6-minute walking test (6minWT) and Gross Motor Function Measure (GMFM-88) in children with acquired brain injury or cerebral palsy. These findings aid clinicians in assessing treatment effectiveness for pediatric gait disorders.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- The minimum clinically important difference (MCID) quantifies clinical relevance in treatment outcomes.
- Establishing MCIDs for pediatric gait disorders is crucial for evaluating therapeutic interventions.
Purpose of the Study:
- To determine the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88).
- To provide benchmarks for assessing treatment effectiveness in pediatric patients with gait disorders.
Main Methods:
- A cohort, pretest-posttest study involving 182 pediatric patients with acquired brain injury (ABI) or cerebral palsy (CP).
- Patients underwent robot-assisted gait training and physical therapy over 4 weeks.
- MCIDs were calculated using 5 distribution-based methods and a clinical professional survey.
Main Results:
- MCID ranges for 6minWT in ABI patients were 20-38m; for CP patients, 6-23m.
- MCID ranges for GMFM-88 total score were 1.1%-5.3% (ABI) and 0.1%-3.0% (CP).
- Specific MCID ranges were also determined for GMFM-88 dimensions D and E across both populations.
Conclusions:
- This study provides the first MCID ranges for 6minWT and GMFM-88 in pediatric neurological impairments.
- Clinicians can use these MCIDs to better evaluate treatment impacts.
- Caution is advised with distribution-based methods; consensus- and anchor-based approaches should complement findings.
Objective:
The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders.
Methods:
A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals.
Results:
The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension "D" of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension "E," MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods.
Conclusions:
This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.
