title: Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
abstract: OBJECTIVE
  To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke.
  
  
  METHODS
  Prospective case series discharged over a 9-month period.
  
  
  METHODS
  Long-term acute care hospital.
  
  
  METHODS
  Patients with stroke (N=113).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Admission, discharge, and change scores were calculated for the total FIM, motor FIM, and cognitive FIM. Assessments of clinical change were rated at discharge on a 15-point (-7 to +7) Likert scale by attending physicians, with MCID defined at a cutoff score of 3. The FIM change scores associated with MCID were identified from receiver operating characteristic curves. Bayesian analysis was used to determine the probability of individual patients achieving MCID.
  
  
  RESULTS
  FIM change scores associated with MCID were 22, 17, and 3 for the total FIM, motor FIM, and cognitive FIM, respectively. The accuracy of the MCID was greater when subjects were categorized based on admission FIM scores than when considering the sample as a whole. Larger FIM change scores were related to MCID in subjects with lower admission FIM scores.
  
  
  CONCLUSIONS
  These findings will assist in the interpretation of FIM change scores relative to physicians' assessments of important clinical change.
authors.affiliation: Graduate Programs in Physical Therapy, MGH Institute of Health Professions, Boston, MA 02129, USA. mbeninato@mghihp.edu
authors.forename: Marianne
authors.initials: M
authors.lastname: Beninato
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gill-Body
authors.forename: Sara
authors.initials: S
authors.lastname: Salles
authors.forename: Paul C
authors.initials: PC
authors.lastname: Stark
authors.forename: Randie M
authors.initials: RM
authors.lastname: Black-Schaffer
authors.forename: Joel
authors.initials: J
authors.lastname: Stein
mesh_terms: D000203:Activities of Daily Living / Q000145:classification*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D026741:Physical Therapy Modalities; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome