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Letter to the Editor Re: Author’s Response to Letter to the Editor

Published:March 07, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.022
      We appreciate the authors’ response to our letter,
      • Uda K.
      • Mph P.T.
      • Yasunaga H.
      Author’s response to letter to the editor.
      but we believe their response is insufficient to address our point. In their response they stated, “We believe that the MCID of the BI in both studies was not directly applicable to our study because of differences in the population or length of follow-up. We focused on patients with mild to severe dementia who underwent hip fracture surgery and examined the BI at discharge from acute-care hospitals (median [25th-75th percentile] postoperative length of stay, 21d [15-30d]).3 We believe that the clinical importance of changes in the BI differ with different patient populations or clinical settings.” We somewhat agree that the findings of the earlier studies that we mentioned in our letter
      • Ikeda T.
      • Tsuboya T.
      Intensive in-hospital rehabilitation after hip fracture surgery and activities of daily living in patients with dementia: retrospective analysis of a nationwide inpatient database.
      might not be generalized to patients with mild-severe dementia after hip fracture surgery in Uda’s study. Still, we understand Uda et al have not addressed our raised point whether their finding is beyond clinical significance. We believe we researchers should be humble about use of clinical or statistical significance, especially when we deal with big data.
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      References

        • Uda K.
        • Mph P.T.
        • Yasunaga H.
        Author’s response to letter to the editor.
        Arch Phys Med Rehabil. 2019; 101: 172
        • Ikeda T.
        • Tsuboya T.
        Intensive in-hospital rehabilitation after hip fracture surgery and activities of daily living in patients with dementia: retrospective analysis of a nationwide inpatient database.
        Arch Phys Med Rehabil. 2020; 101: 171-172

      Linked Article

      • Author’s Response to Letter to the Editor
        Archives of Physical Medicine and RehabilitationVol. 101Issue 6
        • Preview
          We thank the authors for their reply to our most recent response. However, we believe that our findings were clinically significant. Specifically, we believe that a 5-point improvement in the Barthel Index (BI) is clinically meaningful. Such an increase can be interpreted by patients and clinicians as an improvement in at least 1 level of dependence in 1 task of activities of daily living.
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