title: Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation.
abstract: OBJECTIVE
  To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation.
  
  
  METHODS
  Secondary analyses of patients who received stroke rehabilitation therapy.
  
  
  METHODS
  Medical centers.
  
  
  METHODS
  Patients with stroke (N=78).
  
  
  METHODS
  Secondary analyses of patients who received 1 of 4 rehabilitation interventions.
  
  
  METHODS
  Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC(90)), and MCID on the NEADL score and percentages of patients exceeding the MDC(90) and MCID.
  
  
  RESULTS
  The SRM of the total NEADL scale was 1.3. The MDC(90) value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC(90) and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively.
  
  
  CONCLUSIONS
  The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates.
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Clinical Behavioral Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ching-yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Li-ling
authors.initials: LL
authors.lastname: Chuang
authors.forename: Keh-chung
authors.initials: KC
authors.lastname: Lin
authors.forename: Shin-da
authors.initials: SD
authors.lastname: Lee
authors.forename: Wei-hsien
authors.initials: WH
authors.lastname: Hong
mesh_terms: D000203:Activities of Daily Living; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation