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Responsiveness and Minimal Clinically Important Difference of the Motor Function Measure in Collagen VI-Related Dystrophies and Laminin Alpha2-Related Muscular Dystrophy

Published:November 05, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.116

      Abstract

      Objectives

      To investigate the responsiveness of the motor function measure (MFM) and determine the minimal clinically important difference (MCID) in individuals with 2 common types of congenital muscular dystrophy (CMD).

      Design

      Observational, prospective, single center, cohort study.

      Setting

      National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH).

      Participants

      Individuals (N=44) with collagen VI-related dystrophies (COL6-RD, n=23) and 21 individuals laminin alpha2-related muscular dystrophy (LAMA2-RD, n=21) enrolled in a 4-year longitudinal natural history study.

      Interventions

      Not applicable.

      Main Outcome Measures

      Responsiveness of the MFM-32 and the Rasch-scaled MFM-25 and the MCID of the MFM-32 determined from a patient-reported anchor with 2 different methods, within-patient and between-patient.

      Results

      The original MFM-32 and Rasch-scaled MFM-25 performed similarly overall in both the COL6-RD and LAMA2-RD populations, with all subscores (D1, standing and transfers; D2, axial and proximal; D3, distal) showing a significant decrease over time, except MFM D1 and D3 for LAMA2-RD. The MFM D1 subscore was the most sensitive to change for ambulant individuals, whereas the MFM D2 subscore was the most sensitive to change for nonambulant individuals. The MCID for the MFM-32 total score was calculated as 2.5 and 3.9 percentage points according to 2 different methods.

      Conclusions

      The MFM showed strong responsiveness in individuals with LAMA2-RD and COL6-RD. Because a floor effect was identified more prominently with the Rasch-Scaled MFM-25, the use of the original MFM-32 as a quantitative variable with the assumption of scale linearity appears to be a good compromise. When designing clinical trials in congenital muscular dystrophies, the use of MCID for MFM should be considered to determine if a given intervention effects show not only a statistically significant change but also a clinically meaningful change.

      Keywords

      List of abbreviations:

      6WMT (6-minute walk test), CMD (congenital muscular dystrophy), COL6-RD (collagen VI-related dystrophy), D1 (motor function measure D1 subscore), D2 (motor function measure D2 subscore), D3 (motor function measure D3 subscore), DMD (Duchenne muscular dystrophy), LAMA2-RD (laminin, alpha2-related muscular dystrophy), MCID (minimal clinically important difference), MFM (motor function measure), NIH (National Institutes of Health), NMD (neuromuscular disease), SMA (spinal muscular atrophy), TS (motor function measure total score)
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