Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2011

Open Access 01-12-2011 | Research

Assessing the Stroke-Specific Quality of Life for Outcome Measurement in Stroke Rehabilitation: Minimal Detectable Change and Clinically Important Difference

Authors: Keh-chung Lin, Tiffany Fu, Ching-yi Wu, Ching-ju Hsieh

Published in: Health and Quality of Life Outcomes | Issue 1/2011

Login to get access

Abstract

Background

This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke.

Methods

MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC95). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported.

Results

The MDC95 of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively.

Conclusions

The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.
Literature
1.
Lavados PM, Hennis AJM, Fernandes JG, et al.: Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol 2007, 6: 362–372. 10.1016/S1474-4422(07)70003-0PubMedCrossRef
2.
Mar J, Sainz-Ezkerra M, Moler-Cuiral JA: Calculation of prevalence estimates through differential equations: application to stroke-related disability. Neuroepidemiology 2008, 31: 57–66. 10.1159/000140096PubMedCrossRef
3.
Muus I, Petzold M, Ringsberg KC: Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke. Scand J Caring Sci 2010,24(2):211–8. 10.1111/j.1471-6712.2009.00705.xPubMedCrossRef
4.
Aprile I, Piazzini DB, Bertolini C, et al.: Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation. Neurol Sci 2006, 27: 40–46. 10.1007/s10072-006-0563-5PubMedCrossRef
5.
Dhamoon MS, Moon YP, Paik MC, et al.: Long-term functional recovery after first ischemic stroke: The Northern Manhattan study. Stroke 2009, 40: 2805–2811. 10.1161/STROKEAHA.109.549576PubMedCentralPubMedCrossRef
6.
Bowling A: Measuring Health: A Review of Quality of Life Measurement Scales. 3rd edition. Maidenhead, Berkshire, England: Open University Press; 2005.
7.
Carod-Artal FJ, Egido JA: Quality of life after stroke: the importance of a good recovery. Cerebrovasc Dis 2009, 27: 204–214. 10.1159/000200461PubMedCrossRef
8.
Graham A: Measurement in stroke: activity and quality of life. In Recovery after Stroke. Edited by: Barnes MP, Dobkin BH, Bogusslavsky J. New York: Cambridge University Press; 2005:135–160.
9.
Kissela B: The value of quality of life research in stroke. Stroke 2006, 37: 1958–1959. 10.1161/01.STR.0000234047.57744.d9PubMedCrossRef
10.
Lima RCM, Teixeira-Salmela LF, Magalhaes LC, Gomes-Neto M: Psychometric properties of the Brazilian version of the Stroke Specific Quality of Life Scale: application of the Rasch model. Rev Bras Fisioter 2008, 12: 149–156.
11.
Noble AJ, Schenk T: Which variables help explain the poor health-related quality of life after subarachnoid hemorrhage? A meta-analysis. Neurosurgery 2010, 66: 772–783. 10.1227/01.NEU.0000367548.63164.B2PubMedCrossRef
12.
Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ: Improving the evaluation of therapeutic interventions in multiple sclerosis: development of a patient-based measure of outcome. Health Technol Assess 2004,8(9):.
13.
Williams LS, Weinberger M, Harris LE, Clark DO, Biller J: Development of a Stroke-Specific Quality of Life Scale. Stroke 1999, 30: 1362–1369.PubMedCrossRef
14.
Duncan PW, Bode RK, Lai SM, Perera S: Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil 2003, 84: 950–963. 10.1016/S0003-9993(03)00035-2PubMedCrossRef
15.
Salter KL, Moses MB, Foley NC, Teasell RW: Health-related quality of life after stroke: what are we measuring? Int J Rehabil Res 2008, 31: 111–117. 10.1097/MRR.0b013e3282fc0f33PubMedCrossRef
16.
Chou PC, Chu HY, Lin JG: Effects of electroacupuncture treatment on impaired cognition and quality of life in Taiwanese stroke patients. J Altern Complement Med 2009, 15: 1067–1073.PubMed
17.
Kendall E, Catalano T, Kuipers P, Posner N, Buys N, Charker J: Recovery following stroke: the role of self-management education. Soc Sci Med 2007, 64: 735–746. 10.1016/j.socscimed.2006.09.012PubMedCrossRef
18.
Muus I, Williams LS, Ringsberg KC: Validation of the Stroke Specific Quality of Life scale (SS-QOL): test of reliability and validity of the Danish version (SS-QOL-DK). Clin Rehabil 2007, 21: 620–627. 10.1177/0269215507075504PubMedCrossRef
19.
Verbunt JA, Seelen HAM, Ramos FP, Michielsen BHM, Wetzelaer WL, Moennekens M: Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial. BMC Neurol 2008, 8: 7. 10.1186/1471-2377-8-7PubMedCentralPubMedCrossRef
20.
Ewert T, Stucki G: Validity of the SS-QOL in Germany and in survivors of hemorrhagic or ischemic stroke. Neurorehabil Neural Repair 2007, 21: 161–168. 10.1177/1545968306292255PubMedCrossRef
21.
Boosman H, Passier PECA, Visser-Meily JMA, Rinkel GJE, Post MWM: Validation of the Stroke-Specific Quality of Life Scale (SS-QOL) in patients with aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2010,81(5):485–9. 10.1136/jnnp.2009.184960PubMedCrossRef
22.
Teixeira-Salmela LF, Gomes-Neto M, Magalhaes LC, Lima RCM, Faria CDCM: Content comparisons of stroke-specific quality of life based upon the international classification of functioning, disability, and health. Qual Life Res 2009, 18: 765–773. 10.1007/s11136-009-9488-9PubMedCrossRef
23.
Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice. 3rd edition. Upper Saddle River, NJ: Pearson/Prentice Hall; 2009.
24.
Lin KC, Fu T, Wu CY, et al.: Minimal detectable change and clinically important difference of the Stroke Impact Scale in stroke patients. Neurorehabil Neural Repair 2010, in press.
25.
Plummer P, Behrman AL, Duncan PW, et al.: Effects of stroke severity and training duration on locomotor recovery after stroke: a pilot study. Neurorehabil Neural Repair 2007, 21: 137–151. 10.1177/1545968306295559PubMedCrossRef
26.
Evans MD, Goldie PA, Hill KD: Systematic and random error in repeated measurements of temporal and distance parameters of gait after stroke. Arch Phys Med Rehabil 1997, 78: 725–729. 10.1016/S0003-9993(97)90080-0PubMedCrossRef
27.
Perry J, Garrett M, Gronley JK, et al.: Classification of walking handicap in the stroke population. Stroke 1995, 26: 982–989.PubMedCrossRef
28.
Wu CY, Chuang LL, Lin KC, Chen HC, Tsay PW: Randomized trial of distributed constraint-induced therapy versus bilateral arm training for the rehabilitation of upper-limb motor control and function after stroke. Neurorehabil Neural Repair 2010, in press.
29.
Lin KC, Chang YF, Wu CY, Chen YA: Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabil Neural Repair 2009, 23: 441–448. 10.1177/1545968308328719PubMedCrossRef
30.
Bouffioulx E, Arnould C, Thonnard JL: A satisfaction measure of activities and participation in the actual environment experienced by patients with chronic stroke. J Rehabil Med 2008, 40: 836–843.PubMedCrossRef
31.
Brunnstrom S: Movement Therapy in Hemiplegia. New York, NY: Harper & Row; 1970.
32.
Folstein MF, Folstein SE, McHugh PR: "Mini-mental State." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189–198. 10.1016/0022-3956(75)90026-6PubMedCrossRef
33.
Bohannon R, Smith M: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987, 67: 206–207.PubMed
34.
Hsueh IP, Cheng CC, Jeng JS, Hsieh CL: Development of a scale measuring self-perceived difficulty in performing ADL for stroke patients. Proceedings of the Symposium of Occupational Therapy: 7 April 2005; Taipei 2005.
35.
Visser-Meily JMA, Rhebergen ML, Rinkel GJE, van Zandvoort MJ, Post MWM: Long-term health-related quality of life after aneurysmal subarachnoid hemorrhage: Relationship with psychological symptoms and personality characteristics. Stroke 2009, 40: 1526–1529. 10.1161/STROKEAHA.108.531277PubMedCrossRef
36.
Schmitt JS, Fabio RPD: Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol 2004, 57: 1008–1018. 10.1016/j.jclinepi.2004.02.007PubMedCrossRef
37.
de Vet HCW, Terwee CB, Knol DL, Bouter LM: When to use agreement versus reliability measures. J Clin Epidemio 2006, 59: 1033–1039. 10.1016/j.jclinepi.2005.10.015CrossRef
38.
Guyatt GH, Osoba D, Wu AW, et al.: Methods to explain the clinical significance of health status measures. Mayo Clin Proc 2002, 77: 371–383. 10.4065/77.4.371PubMedCrossRef
39.
Cohen JW: Statistical Power Analysis for the Behavior Sciences. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
40.
Ringash J, O'Sullivan B, Bezjal A, Redelmeier DA: Interpreting clinically significant changes in patient-reported outcomes. Cancer 2007, 110: 196–202. 10.1002/cncr.22799PubMedCrossRef
41.
Norman GR, Sloan JA, Wyrwich KW: Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003, 41: 582–592. 10.1097/00005650-200305000-00004PubMed
42.
Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW: Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil 2008, 89: 1693–1700. 10.1016/j.apmr.2008.02.022PubMedCentralPubMedCrossRef
43.
Cella D, Hahn EA, Dineen K: Meaningful change in cancer-specific quality of life scores: Differences between improvement and worsening. Qual Life Res 2002, 11: 207–221. 10.1023/A:1015276414526PubMedCrossRef
44.
Zisapel N, Nir T: Determination of the minimal clinically significant difference on a patient visual analog sleep quality scale. J Sleep Res 2003, 12: 291–298. 10.1046/j.0962-1105.2003.00365.xPubMedCrossRef
45.
Iyer LV, Haley SM, Watkins MP, Dumas HM: Establishing miniml clinically important differences for scores on the pediatric evaluation of disability inventory for inpatient rehabilitation. Phys Ther 2003, 83: 888–898.PubMed
46.
Hagg O, Fritzell P, Nordwall A: The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003, 12: 12–20.PubMed
47.
Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ: The Stroke Impact Scale version 2.0: evaluation of reliability, validity and sensitivity to change. Stroke 1999, 30: 2131–2140.PubMedCrossRef
48.
Crosby RD, Kolotkin RL, Williams GR: Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 2003, 56: 395–407. 10.1016/S0895-4356(03)00044-1PubMedCrossRef
49.
Santanello NC, Zhang J, Seidenberg B, Reiss TF, Barber BL: What are minimal important changes for asthma measures in a clinical trial? Eur Respir J 1999, 14: 23–27. 10.1034/j.1399-3003.1999.14a06.xPubMedCrossRef
50.
Revicki D, Hays RD, Cella D, Sloan J: Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 2008, 61: 102–109. 10.1016/j.jclinepi.2007.03.012PubMedCrossRef
51.
Hsieh YW, Wang CH, Sheu CF, Hsueh IP, Hsieh CL: Estimating the minimal clinically important difference of the Stroke Rehabilitation Assessment of Movement measure. Neurorehabil Neural Repair 2008, 22: 723–727. 10.1177/1545968308316385PubMedCrossRef
52.
Fritz SL, George SZ, Wolf SL, Light KE: Participant perception of recovery as criterion to establish important of improvement for constraint-induced movement therapy outcome measures: a preliminary study. Phys Ther 2007, 87: 170–178. 10.2522/ptj.20060101PubMedCrossRef
53.
Kupferberg DH, Kaplan RM, Slymen DJ, Ries AL: Minimal clinically important difference for the UCSD Shortness of Breath Questionnaire. J Cardiopulm Rehabil 2005, 25: 370–377. 10.1097/00008483-200511000-00011PubMedCrossRef
54.
Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD: Linking clinical relevance and statistical significance in evaluating intraindividual changes in health-related quality of life. Med Care 1999, 37: 469–478. 10.1097/00005650-199905000-00006PubMedCrossRef
55.
Wyrwich KW, Tierney WM, Wolinsky FD: Further evidence supporting an SEM-based criterion for identifying meaningful intraindividual changes in health-related quality of life. J Clin Epidemiol 1999, 52: 861–873. 10.1016/S0895-4356(99)00071-2PubMedCrossRef
56.
Wyrwich KW, Tierney WM, Wolinsky FD: Using the standard error of measurement to identify important changes on the Asthma Quality of Life Questionnaire. Qual Life Res 2002, 11: 1–7. 10.1023/A:1014485627744PubMedCrossRef
57.
Jordan K, Dunn KM, Lewis M, Croft P: A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain. J Clin Epidemiol 2006, 59: 45–52. 10.1016/j.jclinepi.2005.03.018PubMedCrossRef
58.
Leidy NK, Wyrwich KW: Bridging the gap: Using triangulation methodology to estimate minimal clinically important differences (MCIDs). COPD 2005, 2: 157–165. 10.1081/COPD-200050508PubMedCrossRef
59.
Cella D, Bullinger M, Scott C, Barofsky I: Group vs. individual approaches to understanding the clinical significance of differences or changes in quality of life. Mayo Clin Proc 2002, 77: 384–392. 10.4065/77.4.384PubMedCrossRef
60.
Dawson J, Doll H, Coffey J, Jenkinson C: Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage 2007, 15: 918–931. 10.1016/j.joca.2007.02.003PubMedCrossRef
61.
Resnik L, Dobrykowski E: Outcomes measurement for patients with low back pain. Orthop Nurs 2005, 24: 14–24. 10.1097/00006416-200501000-00007PubMedCrossRef
62.
Norman G, Stratford P, Regehr G: Methodological problems in the retrospective computation of responsiveness to change: the lessons of Cronbach. J Clin Epidemiol 1997, 50: 869–879. 10.1016/S0895-4356(97)00097-8PubMedCrossRef
63.
Schwartz N, Sudman S: Autobiographical memory and the validity of retrospective reports. New York: Springer-Verlag; 1994.CrossRef
64.
Davidson M, Keating JL: A comparison of five Low Back Disability Questionnaires: reliability and responsiveness. Phys Ther 2002, 82: 8–24.PubMed
65.
Barratt A, Wyer PC, Hatala R, et al.: Tips for teachers of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ 2004, 171: 353–358.PubMedCentralPubMedCrossRef
66.
Schmitt JS, Di Fabio RP: Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol 2004, 57: 1008–1018. 10.1016/j.jclinepi.2004.02.007PubMedCrossRef
67.
Faber J, Bosscher RJ, van Wieringen PC: Clinimetric properties of the performance-oriented mobility assessment. Phys Ther 2006, 86: 944–954.PubMed
68.
Twiss J, Doward LC, McKenna SP, Eckert B: Interpreting scores on multiple sclerosis-specific patient reported outcome measures (the PRIMUS and U-FIS). Health Qual Life Outcome 2010, 8: 117. 10.1186/1477-7525-8-117CrossRef
69.
Williams LS, Bakas T, Brizendine E, et al.: How valid are family proxy assessments of stroke patients' health-related quality of life? Stroke 2006, 37: 2081–2085. 10.1161/01.STR.0000230583.10311.9fPubMedCrossRef
70.
Gundy CM, Aaronson NK: Effects of mode of administration (MOA) on the measurement properties of the EORTC QLQ-C30: a randomized study. Health Qual Life Outcomes 2010, 8: 35. 10.1186/1477-7525-8-35PubMedCentralPubMedCrossRef
Metadata
Title
Assessing the Stroke-Specific Quality of Life for Outcome Measurement in Stroke Rehabilitation: Minimal Detectable Change and Clinically Important Difference
Authors
Keh-chung Lin
Tiffany Fu
Ching-yi Wu
Ching-ju Hsieh
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2011
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-9-5

Other articles of this Issue 1/2011

Health and Quality of Life Outcomes 1/2011 Go to the issue

Research

Performance and cross-cultural comparison of the short-form version of the CPQ11-14 in New Zealand, Brunei and Brazil

Research

Comparison of health-related quality of life measures in chronic obstructive pulmonary disease

Research

Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain

Research

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

Research

Determinants of agreement between self-reported and parent-assessed quality of life for children in Germany-results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Research

Stress-related psycho-physiological disorders: randomized single blind placebo controlled naturalistic study of psychometric evaluation using a radio electric asymmetric treatment