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Minimal Clinically Important Difference of Berg Balance Scale in People With Multiple Sclerosis

Published:October 24, 2016DOI:https://doi.org/10.1016/j.apmr.2016.09.128

      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)
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