Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.
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.
Beninato
Marianne
M
Graduate Programs in Physical Therapy, MGH Institute of Health Professions, Boston, MA 02129, USA. mbeninato@mghihp.edu
Gill-Body
Kathleen M
KM
Salles
Sara
S
Stark
Paul C
PC
Black-Schaffer
Randie M
RM
Stein
Joel
J
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