Minimal detectable change of gait and balance measures in older neurological patients: estimating the standard error of the measurement from before-after rehabilitation data thanks to the linear mixed-effects models.
Antonio Caronni, Michela Picardi, Stefano Scarano and 4 others
PMID 38566189WHAT IT FOUND
Gait speed and total TUG time are reliable enough to track change in older neurological patients.
Use a three-repetition protocol: discard the first, average the next two. A real change requires about 15% improvement or decline. Inertial sensor metrics for sit-to-walk and turning were too noisy to be useful.
Key findings
01Gait speed and TUG test duration have low measurement error, requiring only about 15% change from baseline to be considered a real clinical improvement or decline.
02A shortened assessment protocol (three repetitions, discarding the first and averaging the next two) matches the accuracy of the standard five-repetition test for gait speed and total TUG time.
03Inertial sensor measures of sit-to-walk duration and turning duration had high measurement error, requiring 40-50% change to detect real improvement, making them less clinically useful than stopwatch measures.
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 grouped different neurological conditions (stroke, neuropathy, parkinsonism) together, so the MDC values may not be precise for each specific diagnosis. The analysis used data from a rehabilitation setting where patients improved, which violates the standard 'steady-state' assumption for reliability testing, though the authors corrected for this statistically. The MDC values are expressed as percentages for some measures, which requires the clinician to calculate the specific threshold for each patient's baseline score.
Declared interests
The study was funded by Ricerca Corrente from the Italian Ministry of Health. No commercial conflicts of interest were declared.
The easy way to misread this
Do not use the sit-to-walk or turning duration metrics from inertial sensors to judge individual patient progress. The measurement error is so high that a patient would need to improve by 40-50% to show a real change, which is unlikely in most clinical scenarios.