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Minimal Clinically Important Difference (MCID) in the Functional Status Measures in Patients with Stroke: Inverse
Yu-Chien Chang1, Hsiu-Fen Lin2,3, Yu-Fu Chen4
1Division of Neurology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung 80249, Taiwan.
Abstract:
This study proposed to evaluate the temporal trend, define the minimal clinically important difference (MCID) for five functional status measures, and identify risk factors for reaching deterioration in the MCID. This prospective cohort study analyzed 680 patients with ischemic stroke and 151 patients with hemorrhagic stroke at six hospitals between April 2015 and October 2021. All patients completed the functional status measures before rehabilitation (baseline), and at the 12th week and 2nd year after rehabilitation. Patients in the post-acute care (PAC) group exhibited significantly larger improvements for the functional status measures compared to those in the non-PAC group (p < 0.05). Patients with hemorrhagic stroke also displayed larger improvements in the functional status measures when compared to patients with ischemic stroke. Furthermore, the improvement in MCID ranged from 0.01 to 16.18 points when comparing baseline and the 12th week after rehabilitation, but the deterioration in MCID ranged from 0.38 to 16.12 points. Simultaneously, assessing the baseline and the second year after rehabilitation, the improvement in MCID ranged from 0.01 to 18.43 points, but the deterioration in MCID ranged from 0.68 to 17.26 points. Additionally, the PAC program, age, education level, body mass index, smoking, readmission within 30 days, baseline functional status score, use of Foley catheter and nasogastric tube, as well as a history of previous stroke are significantly associated with achieving deterioration in MCID (p < 0.05). These findings suggest that if the mean change scores of the functional status measures have reached the thresholds, the change scores can be perceived by patients as clinically important.
Insights
Patients receiving post-acute care (PAC) and those with hemorrhagic stroke showed greater functional status improvements after rehabilitation. Several factors, including PAC participation and stroke type, influence clinically important changes in functional status measures.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Outcomes Research
Background:
- Stroke recovery involves functional status changes over time.
- Defining clinically meaningful improvements is crucial for patient-centered care.
- Identifying factors influencing functional recovery aids in personalized rehabilitation strategies.
Purpose of the Study:
- To evaluate temporal trends in functional status after stroke.
- To define the minimal clinically important difference (MCID) for functional status measures.
- To identify risk factors associated with deterioration in MCID.
Main Methods:
- Prospective cohort study of 831 stroke patients (680 ischemic, 151 hemorrhagic).
- Functional status measures assessed at baseline, 12 weeks, and 2 years post-rehabilitation.
- Statistical analysis to determine MCID and associated risk factors.
Main Results:
- Post-acute care (PAC) patients and hemorrhagic stroke patients showed significantly greater functional improvements.
- MCID improvement ranged from 0.01 to 18.43 points; deterioration ranged from 0.38 to 17.26 points.
- PAC, age, stroke type, and baseline status were significant predictors of MCID deterioration.
Conclusions:
- Functional status improvements in stroke patients can be clinically meaningful.
- PAC participation and hemorrhagic stroke type are associated with better outcomes.
- Understanding risk factors for deterioration can guide interventions to optimize recovery.
