Establishing minimal clinically important difference of modified dynamic gait index in people with subacute stroke.

Abstract

Background: People with stroke (PwST) often have significant balance limitations, making it crucial to focus rehabilitation on improving mobility and reducing the risk of falls. The Modified Dynamic Gait Index (MDGI) is recommended for measuring balance in various neurological conditions, but a minimal clinically important difference (MCID) score specific to PwST is missing.

Objectives: To calculate the MCID of the MDGI in PwST during the subacute phase.

Methods: This study is a secondary analysis utilizing data from an observational longitudinal study. Forty-four PwST met the inclusion criteria such as age > 18 years, diagnosis of cerebral infarction or hemorrhage within 180 days, and Mini-Mental State Examination ≥ 21. Participants received at least 10 sessions of tailored physiotherapy to improve balance and gait. Balance was assessed using the MDGI and the Activities-specific Balance Confidence Scale (ABC) before and after intervention. The MCID was determined using an anchor-based approach, with the ABC serving as the anchor.

Results: Statistically significant improvements were observed in mean MDGI change scores of 19.5(14.6) points, (p < 0.01) and ABC change scores of 27.1(25.3) points, (p < 0.01). The MCID for the MDGI total score was identified as 17.5 points. The Spearman correlation between MDGI and ABC change scores was 0.51 (p < 0.01).

Conclusions: An MCID of 17.5 points for the MDGI total score indicates clinically meaningful improvements in balance and gait performance in subacute PwST undergoing rehabilitation. This value provides a robust metric for evaluating the efficacy of balance-related interventions in this population.