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Minimal Clinically Important Difference of the Four Square Step Test in people with Degenerative Spinal Conditions

  • Author Footnotes
    1 Twitter handle @PRUOxford.
    Martha Batting
    Correspondence
    Corresponding author. Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Windmill Road, Headington, OX3 7HE, UK. Tel.: +01865 737526.
    Footnotes
    1 Twitter handle @PRUOxford.
    Affiliations
    Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, UK
    Search for articles by this author
  • Author Footnotes
    1 Twitter handle @PRUOxford.
    Erin Hannink
    Footnotes
    1 Twitter handle @PRUOxford.
    Affiliations
    Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, UK
    Search for articles by this author
  • Author Footnotes
    1 Twitter handle @PRUOxford.
    Karen Barker
    Footnotes
    1 Twitter handle @PRUOxford.
    Affiliations
    Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, UK
    Search for articles by this author
  • Author Footnotes
    1 Twitter handle @PRUOxford.

      Abstract

      Objective

      To identify the minimal clinically important difference (MCID) in the Four Square Step Test (FSST) for patients with degenerative spinal conditions before and after a six-week group-based physiotherapy programme.

      Design

      Secondary analysis of a longitudinal cohort study

      Setting

      Physiotherapy department within a specialised orthopaedic hospital in the UK

      Participants

      Men and women with degenerative spinal conditions

      Interventions

      All participants had a routine care package of up to six group-based physiotherapy led exercise and education sessions.

      Main outcome measures

      An anchor-based approach using a self-report outcome measure (Activities-specific Balance Confidence [ABC] Scale) was utilised as a comparator to determine the MCID of the FSST. The MCID for the FSST was calculated as the difference in mean change scores from those who improved on the ABC Scale against those who did not improve (based on the standard error of measurement of the ABC Scale).

      Results

      Twenty-eight participants with degenerative spinal conditions (19 female) had a mean age of 73years (SD 7.7). The mean ABC Scale scores for the whole sample were 61% (SD 19.1) at baseline and 66% (SD 18.3) post-physiotherapy. The mean FSST scores for the whole sample were 19.1s (SD 9.8) at baseline and 13.9s (SD 6.3) post-physiotherapy. The MCID for the FSST was 3.6 seconds.

      Conclusions

      The MCID for improvement in balance was 3.6 seconds, indicating people with degenerative spinal conditions are likely to perceive an improvement of ≥ 3.6 seconds in their FSST score as an important change in their balance performance and confidence.

      Keywords

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