title: The minimum clinically important improvement in the incremental shuttle walk test following cardiac rehabilitation.
abstract: BACKGROUND
  The aim was to establish the minimum clinically important difference (MCID) in the incremental shuttle walk test (ISWT) following cardiac rehabilitation.
  
  
  METHODS
  This was a service evaluation, utilising anchor- and distribution-based methods.
  
  
  METHODS
  Two hundred and twenty patients performed an ISWT following a six-week cardiac rehabilitation programme comprising supervised aerobic exercise, secondary prevention education and a home exercise programme.
  
  
  METHODS
  Patient perception of change in ISWT distance following cardiac rehabilitation. After completing cardiac rehabilitation, subjects were asked to identify, from a five-point Likert scale, their perceived change in exercise performance (range: from 'better' to 'worse'). Two distribution-based methods were also employed (standard deviation (SD) and effect size). The agreement between all measures was observed.
  
  
  RESULTS
  Mean (SD) age was 65.0 (10.5) years, body mass index 28.4 (5.1), 170 male. The baseline ISWT was 390.8 (173.1) metres (m), which increased to 456.0 (186.7) m (mean change 65.2 (95% confidence interval 55.4-74.9) m after cardiac rehabilitation (p < 0.001)). In those rating their exercise tolerance as 'slightly better', the mean improvement was 70.0 (95% confidence interval 51.5-88.5) m. The SD method yielded a minimum clinically important difference value of 36.65 m and the effect size for the change was 0.38. The agreement between the patients' perception of change and distribution-based methods was poor.
  
  
  CONCLUSIONS
  The minimum clinically important difference for the ISWT following cardiac rehabilitation is 70 m. This patient-reported value is a more sensitive measure and has poor agreement with distribution-based estimates. This value may help clinicians interpret ISWT change in patients, help researchers estimate sample size and aid comparison between studies, when the ISWT is the primary outcome.
authors: Centre for Exercise and Rehabilitation Science (CERS), Respiratory Biomedical Research Unit (BRU), University Hospitals of Leicester NHS Trust, UK Linzy.Houchen@uhl-tr.nhs.uk.
authors: Linzy
authors: L
authors: Houchen-Wolloff
authors: Centre for Exercise and Rehabilitation Science (CERS), Respiratory Biomedical Research Unit (BRU), University Hospitals of Leicester NHS Trust, UK.
authors: Sally
authors: S
authors: Boyce
authors: Centre for Exercise and Rehabilitation Science (CERS), Respiratory Biomedical Research Unit (BRU), University Hospitals of Leicester NHS Trust, UK.
authors: Sally
authors: S
authors: Singh
mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D020127:Recovery of Function; D015203:Reproducibility of Results; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Rehabilitation; exercise; exercise test; outcome assessment; walking