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Minimal Detectable Change and Clinically Important Difference of the Wolf Motor Function Test in Stroke Patients

Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

Yu-wei Hsieh, MS

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

Ching-yi Wu, ScD, OTR

Graduate Institute of Clinical Behavioral Science and Department of Occupational Therapy, Chang Gung University, Tao-yuan, Taiwan, cywu{at}mail.cgu.edu.tw

Chia-ling Chen, MD, PhD

Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Tao-yuan, Taiwan

Yuh Jang, PhD, OTR

Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

Jung-sen Liu, MD, PhD

Department of Medical Education and Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Objectives. This study aimed to establish the minimal detectable change (MDC) and clinically important differences (CID) of the Wolf Motor Function Test (WMFT) in patients with stroke, and to assess the proportions of patients' change scores exceeding the MDC and CID after stroke rehabilitation. Methods. A total of 57 patients received 1 of the 3 treatments for 3 weeks and underwent clinical assessments before and after treatment. The MDC, at 90% confidence (MDC ₉₀), was calculated from the standard error of measurement to indicate a real change for individual patients. Anchor-based and distribution-based approaches were used to triangulate the values of minimal CID. The percentages of patients exceeding the MDC and minimal CID were also examined. Results. The MDC₉₀ of the WMFT was 4.36 for the performance time (WMFT time) and 0.37 for the functional ability scale (WMFT FAS). The minimal CID ranged from 1.5 to 2 seconds on the WMFT time and from 0.2 to 0.4 points on the WMFT FAS. The MDC and CID proportions ranged from 14% to 30% on the WMFT time and from 39% to 65% on the WMFT FAS, respectively. Conclusions. The change score of an individual patient has to reach 4.36 and 0.37 on the WMFT time and WMFT FAS to indicate a real change. The mean change scores of a stroke group on the WMFT time and WMFT FAS should achieve 1.5 to 2 seconds and 0.2 to 0.4 points to be regarded as clinically important changes. Furthermore, the WMFT FAS may be more responsive than the WMFT time based on the results of proportions exceeding the threshold criteria.

Key Words: Minimal detectable change • Clinically important difference • Outcome measures • Upper extremity • Stroke rehabilitation • Wolf Motor Function Test

This version was published on June 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 5, 429-434 (2009)
DOI: 10.1177/1545968308331144


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