Responsiveness, Minimal Clinically Important Difference, and Validity of the MoCA in Stroke Rehabilitation.
Ching-Yi Wu, Shuan-Ju Hung, Keh-Chung Lin and 3 others
PMID 31097928WHAT IT FOUND
MoCA scores rose significantly in 65 stroke survivors after task-oriented therapy.
The smallest clinically important change was estimated at 1.22 or 2.15 points, depending on method. Relationships with some stroke impact domains were fair to good.
Key findings
01Stroke survivors had significantly higher MoCA total scores after therapy (postintervention 25.95 ± 3.77, preintervention 24.42 ± 4.29, p < .001).
02MoCA responsiveness was small by effect size (0.37) and moderate by standardized response mean (0.67); anchor-based MCID was 1.22 and distribution-based MCID was 2.15.
03MoCA total, attention, language and abstraction scores had fair to good concurrent correlations with the Stroke Impact Scale communication subscale (rho = 0.335 to 0.523).
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
There was no control group, so the MoCA score change cannot be attributed to the therapy rather than natural recovery, practice effects, or other rehabilitation. Only patients with MMSE scores of 21 or higher and those able to follow instructions were included, so the findings may not apply to more severe cognitive impairment or comprehension deficits. The sample was from Taiwan and included chronic stroke survivors, so the MCID values may not transfer to other cultural groups or to earlier stroke recovery. Responsiveness and MCID estimates differed by method, so no single MoCA change threshold is clearly established. 4 eligible participants were excluded for incomplete data, leaving 65 for analysis.
The easy way to misread this
Do not read the MoCA score rise as proof that task-oriented therapy improved cognition. The study had no control group, so recovery, practice effects, and therapy cannot be separated.