Abstract
Objective
To identify the minimal clinically important difference (MCID) to define clinically
meaningful patient's improvement on the Berg Balance Scale (BBS) in people with multiple
sclerosis (PwMS) in response to rehabilitation.
Design
Cohort study.
Setting
Neurorehabilitation institute.
Participants
PwMS (N=110).
Interventions
This study comprised inpatients and outpatients who participated in research on balance
and gait rehabilitation. All received 20 rehabilitation sessions with different intensities.
Inpatients received daily treatments over a period of 4 weeks, while outpatients received
2 to 3 treatments per week for 10 weeks.
Main Outcome Measures
An anchor-based approach using clinical global impression of improvement in balance
(Activities-specific Balance Confidence [ABC] Scale) was used to determine the MCID
of the BBS. The MCID was defined as the minimum change in the BBS total score (postintervention
− preintervention) that was needed to perceive at least a 10% improvement on the ABC
Scale. Receiver operating characteristic curves were used to define the cutoff of
the optimal MCID of the BBS discriminating between improved and not improved subjects.
Results
The MCID for change on the BBS was 3 points for the whole sample, 3 points for the
inpatients, and 2 points for the outpatients. The area under the curve was .65 for
the whole sample, .64 for inpatients, and .68 for outpatients.
Conclusions
The MCID for improvement in balance as measured by the BBS was 3 points, meaning that
PwMS are likely to perceive that as a reproducible and clinically important change
in their balance performance.
Keywords
List of abbreviations:
ABC (Activities-specific Balance Confidence), AUC (area under the curve), BBS (Berg Balance Scale), MCID (minimal clinically important difference), PwMS (people with multiple sclerosis)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions.Clin Rehabil. 2009; 23: 824-840
- Validity of six balance disorders scales in persons with multiple sclerosis.Disabil Rehabil. 2006; 28: 789-795
- Reliability of four scales on balance disorders in persons with multiple sclerosis.Disabil Rehabil. 2007; 29: 1920-1925
- Effects of balance exercises on people with multiple sclerosis: a pilot study.Clin Rehabil. 2007; 21: 771-781
- Tailored balance exercises on people with multiple sclerosis: a pilot randomized, controlled study.Mult Scler. 2015; 21: 1055-1063
- Understanding the minimum clinically important difference: a review of concepts and methods.Spine J. 2007; 7: 541-546
- The Activities-specific Balance Confidence (ABC) Scale.J Gerontol A Biol Sci Med Sci. 1995; 50A: M28-M34
- Investigating the minimal important difference in ambulation in multiple sclerosis: a disconnect between performance-based and patient-reported outcomes?.J Neurol Sci. 2014; 347: 268-274
- Challenges for defining minimal clinically important difference (MCID) after spinal cord injury.Spinal Cord. 2015; 53: 84-91
- Determination of minimal clinically important change in early and advanced Parkinson's disease.Mov Disord. 2011; 26: 813-818
- Relationship between perceived and measured changes in walking after stroke.J Neurol Phys Ther. 2012; 36: 115-121
- Measurement properties of the Activities-specific Balance Confidence Scale among individuals with stroke.Disabil Rehabil. 2005; 27: 156-163
- Psychometric properties of activity, self-efficacy, and quality-of-life measures in individuals with Parkinson Disease.Physiother Can. 2011; 63: 47-57
- Summary of comprehensive systematic review: rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Neurology. 2015; 85: 1896-1903
- Minimal clinically important difference of the functional gait assessment in older adults.Phys Ther. 2014; 94: 1594-1603
Article info
Publication history
Published online: October 24, 2016
Footnotes
Supported by a Rehabilitation In Multiple Sclerosis grant: Rehabilitation In Multiple Sclerosis Grant Program and Italian Ministry of Health.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
