Minimal clinically important difference of the lower-extremity fugl–meyer assessment in chronic-stroke

Abstract

Background: The Minimal Clinically Important Difference (MCID), the smallest difference in the treatment outcome, augments both clinical and research practice. The MCID of the Fugl–Meyer assessment: Lower extremity (FMA-LE), an important motor measure in stroke, is not known.

Objective: To estimate MCID score of FMA-LE using an anchor-based approach in chronic poststroke hemiparetic (>6 months) stroke subjects.

Methods: Design: A prospective, observational study. Setting: Occupational therapy department of a rehabilitation institute. Participants: Sixty-five poststroke hemiparetic subjects (Mean age = 44.22 years, 42 men, Mean poststroke duration = 16.42 months). Intervention: The conventional motor therapy based on neurophysiological approaches was provided for the affected lower extremity (30 sessions, 45 min each, 3/week). Outcome Measures: FMA-LE, Functional ambulation classification (FAC), and global rating of patient-perceived changes (GRPPC). Result: The estimated MCID of FMA-LE was found to be a score of 6 using both FAC (sensitivity 90, specificity 94) and GRPPC (sensitivity 87, specificity 91). Conclusion: In chronic poststroke hemiparetic subjects, the computed MCID of FMA-LE is a score of 6. The subjects who achieve a change in a score of 6 on FMA-LE would perceive a meaningful recovery of lower-extremity function than those who do not. The reference value may be utilized in stroke rehabilitation.

Keywords:

• Fugl–Meyer assessment
• Lower extremity
• Minimal clinically important difference
• Stroke rehabilitation
• Motor recovery

Funding

The present study was financially assisted by Pt. Deendayal Upadhyaya Institute for the Physically Handicapped, New Delhi, India.

Conflict of interest

The authors declare that they have no conflict of interest regarding this article.

Ethics approval

The study has been approved by the Institutional ethics committee.