Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients

Agnieszka Guzik; Mariusz Drużbicki; Lidia Perenc; Andżelina Wolan-Nieroda; Andrea Turolla; Paweł Kiper

doi:10.3389/fneur.2021.700190

Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients

Front Neurol. 2021 Sep 1:12:700190. doi: 10.3389/fneur.2021.700190. eCollection 2021.

Authors

Agnieszka Guzik¹, Mariusz Drużbicki¹, Lidia Perenc¹, Andżelina Wolan-Nieroda¹, Andrea Turolla², Paweł Kiper³

Affiliations

¹ Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland.
² Laboratory of Kinematics and Robotics IRCCS San Camillo Hospital, Venice, Italy.
³ Azienda Unità Locale Socio Sanitaria 3 Serenissima Physical Medicine and Rehabilitation Unit, Venice, Italy.

Abstract

Many researchers have pointed out that decreased sagittal range of motion (ROM) in the affected hip joint is a common consequence of stroke, and it adversely affects walking performance and walking speed. Nevertheless, the minimal clinically important differences (MCID) in hip-related kinematic gait parameters post-stroke have not yet been determined. The present study aimed to define MCID values for hip ROM in the sagittal plane i.e., flexion-extension (FE), for the affected and unaffected sides at a chronic stage post-stroke. Fifty participants with hemiparesis due to stroke were enrolled for the study. Four statistical methods were used to calculate MCID. According to the anchor-based approach, the mean change in hip FE ROM achieved by the MCID group on the affected/unaffected side amounted to 5.81°/2.86° (the first MCID estimate). The distribution-based analyses established that the standard error of measurement in the no-change group amounted to 1.56°/1.04° (the second MCID estimate). Measurements based on the third method established that a change of 4.09°/0.61° in the hip ROM corresponded to a 1.85-point change in the Barthel Index. The optimum cutoff value, based on ROC curve analysis, corresponded to 2.9/2.6° of change in the hip sagittal ROM for the affected/unaffected side (the fourth MCID estimate). To our knowledge, this is the first study to use a comprehensive set of statistical methods to determine the MCID for hip sagittal ROM for the affected and unaffected sides at a chronic stage post-stroke. According to our findings, the MCID of the hip FE ROM for the affected side amounts to 5.81° and for the unaffected side to 2.86°, in patients with chronic stroke. This indicator is extremely important because it allows clinical practitioners to assess the effects of interventions administered to patients, and to interpret the significance of improvements in sagittal kinematic parameters of the hip; ultimately, it may facilitate the process of designing effective gait reeducation programs.

Keywords: chronic stroke; gait; hip; minimal clinically important difference; range of motion.