Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis.
Shogo Hiragami, Yu Inoue, Kazuhiro Harada
PMID 31871377WHAT IT FOUND
For convalescent stroke patients with moderate to severe arm weakness, a 12.4-point improvement on the Fugl-Meyer upper extremity score marked the threshold where patients felt their arm function had meaningfully improved in daily life.
Key findings
01The estimated minimal clinically important difference for the total Fugl-Meyer upper extremity score was 12.4 points, representing an 18.8% change.
02Patients who reported a meaningful improvement in daily life showed significantly greater gains in total upper extremity scores than those who did not.
03The wrist and hand subscale required a smaller absolute change (4.9 points) to reach the threshold for meaningful improvement compared to the total score, but a higher percentage change (20.4%).
STILL TO COME
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What it does not show
The study included only 12 participants, which limits the precision of the estimated threshold. The participants were in the convalescent phase with moderate to severe weakness, so these values may not apply to chronic stroke patients or those with mild impairment. The study pooled data from a previous randomized trial regardless of treatment group, which may not reflect the impact of specific interventions.
Declared interests
The authors declared no conflicts of interest. The work was supported by JSPS KAKENHI grant number JP17K12875.
The easy way to misread this
Do not apply the 12.4-point MCID to all stroke patients. This threshold was derived from a small group of convalescent patients with moderate to severe weakness. Patients with different severity levels or in chronic phases may perceive meaningful change at different score thresholds.