Duration of rehabilitation therapy to achieve a minimal clinically important difference in mobility, walking endurance and patient-reported physical health: an observational study.
Nicoline Kool, Jan Kool, Stefan Bachmann
PMID 37987632WHAT IT FOUND
Exercise duration needed for clinically important improvement ranged from 8 to 88 hours.
Neurological patients with MS or Parkinson's required significantly more time than those recovering from knee or hip surgery. Patient-reported health improved with less exercise than mobility or walking endurance measures.
Key findings
01The duration of exercise therapy required to achieve a minimal clinically important difference ranged from 8 to 88 hours across all patients.
02Patients with multiple sclerosis or Parkinson's disease required 25 to 88 hours of exercise, while those after knee or hip surgery required only 8 to 25 hours.
03In all diagnostic groups, patient-reported global physical health required the shortest duration of exercise therapy to achieve a clinically important improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used a distribution-based method to define the minimal clinically important difference for most outcomes, which may overestimate the amount of change needed to be clinically meaningful, particularly for mobility and walking endurance in neurological patients. Anchor-based MCID values were only available for the Timed Up and Go test, so comparisons between methods for other outcomes were not possible. The study was retrospective, relying on routine clinical data, which introduces potential bias and limits control over the specific types of exercise delivered. Results may not apply to patients at later stages of recovery after knee or hip surgery, as those patients might require less exercise to perceive a clinically important difference. Statistical comparisons between diagnostic groups were not performed due to insufficient power.
Declared interests
The authors declared no conflicts of interest. The study was conducted using routine clinical data from Kliniken Valens, Switzerland.
The easy way to misread this
Do not assume that a lack of improvement in TUG or 6MWT scores means the rehabilitation was ineffective. The study used a distribution-based method to define the minimal clinically important difference, which resulted in higher thresholds than anchor-based methods. Patients may have achieved clinically meaningful gains that fell below these statistical thresholds, particularly in mobility and walking endurance.