title: Minimal clinically important difference of the functional gait assessment in older adults.
abstract: BACKGROUND
  The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The minimal clinically important difference (MCID) has yet to be determined for the FGA.
  
  
  OBJECTIVE
  The purposes of this study were to determine: (1) the MCID in the FGA for older community-dwelling adults relative to patients' and physical therapists' estimates of change and (2) the extent of agreement between patients' and physical therapists' estimates of change.
  
  
  METHODS
  This study was a prospective case series.
  
  
  METHODS
  Patients and physical therapists rated the amount of change in balance while walking after an episode of physical therapy for balance retraining on a 15-point global rating of change (GROC) scale. Weighted kappa statistics were calculated to express agreement between patients' and physical therapists' GROC ratings. Functional Gait Assessment change scores were plotted on receiver operating characteristic curves. A cutoff of +3 on the GROC was the criterion used for important change. The optimal FGA change cutoff score for MCID was determined, and sensitivity (SN), specificity (SP), and likelihood ratios (LRs) were calculated.
  
  
  RESULTS
  One hundred thirty-five community-dwelling older adults (average age=78.8 years) and 14 physical therapists participated. There was poor agreement between the patients' and therapists' ratings of change (weighted kappa=.163). The estimated MCID value for the FGA using physical therapists' ratings of change as an anchor was 4 points (SN=0.66, SP=0.84, LR+=4.07, LR-=0.40). No accurate value for the FGA MCID could be determined based on the patients' ratings of change.
  
  
  CONCLUSIONS
  The small sample size was a limitation.
  
  
  CONCLUSIONS
  Poor agreement between therapists' and patients' ratings indicate the need for further communication relative to patient goals. The 4-point MCID value for the FGA can be used for goal setting, tracking patient progress, and program evaluation.
authors.affiliation: M. Beninato, PT, DPT, PhD, Graduate Programs in Physical Therapy, MGH Institute of Health Professions, 36 1st Ave, CNY, Boston, MA 02129 (USA). mbeninato@mghihp.edu.
authors.forename: Marianne
authors.initials: M
authors.lastname: Beninato
authors.affiliation: A. Fernandes, PT, MS, Physical Therapy, Brookline Healthcare Center, Brookline, Massachusetts.
authors.forename: Arlene
authors.initials: A
authors.lastname: Fernandes
authors.affiliation: L.S. Plummer, PT, DPT, MS, NCS, Physical Therapy, MGH Institute of Health Professions.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Plummer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D057566:Self Report; D012678:Sensation Disorders / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D012680:Sensitivity and Specificity