Sensitivity to change and minimal clinically important difference of the Locomotor Capabilities Index-5 in people with lower limb amputation undergoing prosthetic training

Franco Franchignoni, Marco Traballesi, Marco Monticone, Andrea Giordano, Stefano Brunelli, Giorgio Ferriero

Research output: Contribution to journalArticle

Abstract

Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training. Design: Prospective single-group observational study. Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48–69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention. Results: Test–retest reliability of the LCI-5 (n = 30) was high (intraclass correlation coefficient [ICC 2,1 ] = 0.92). The minimum detectable change at the 95% confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve ≥ 0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating “large improvement” in locomotor capabilities (12.5% and 21.4% of the maximum possible score, respectively). Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training.

Original languageEnglish
JournalAnnals of Physical and Rehabilitation Medicine
DOIs
Publication statusPublished - Jan 1 2019

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Amputation
Lower Extremity
ROC Curve
Reproducibility of Results
Area Under Curve
Observational Studies
Minimal Clinically Important Difference

Keywords

  • Leg prosthesis
  • Lower-limb amputation
  • Outcome assessment
  • Prosthetic training
  • Psychometrics
  • Rehabilitation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Rehabilitation

Cite this

@article{d5885762dc774827910ec775ba9f0ffc,
title = "Sensitivity to change and minimal clinically important difference of the Locomotor Capabilities Index-5 in people with lower limb amputation undergoing prosthetic training",
abstract = "Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training. Design: Prospective single-group observational study. Methods: The LCI-5 was administered to 110 patients (69 males [63{\%}]; median [interquartile range] age, 60 [48–69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention. Results: Test–retest reliability of the LCI-5 (n = 30) was high (intraclass correlation coefficient [ICC 2,1 ] = 0.92). The minimum detectable change at the 95{\%} confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve ≥ 0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating “large improvement” in locomotor capabilities (12.5{\%} and 21.4{\%} of the maximum possible score, respectively). Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training.",
keywords = "Leg prosthesis, Lower-limb amputation, Outcome assessment, Prosthetic training, Psychometrics, Rehabilitation",
author = "Franco Franchignoni and Marco Traballesi and Marco Monticone and Andrea Giordano and Stefano Brunelli and Giorgio Ferriero",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.rehab.2019.02.004",
language = "English",
journal = "Annals of Physical and Rehabilitation Medicine",
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T1 - Sensitivity to change and minimal clinically important difference of the Locomotor Capabilities Index-5 in people with lower limb amputation undergoing prosthetic training

AU - Franchignoni, Franco

AU - Traballesi, Marco

AU - Monticone, Marco

AU - Giordano, Andrea

AU - Brunelli, Stefano

AU - Ferriero, Giorgio

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training. Design: Prospective single-group observational study. Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48–69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention. Results: Test–retest reliability of the LCI-5 (n = 30) was high (intraclass correlation coefficient [ICC 2,1 ] = 0.92). The minimum detectable change at the 95% confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve ≥ 0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating “large improvement” in locomotor capabilities (12.5% and 21.4% of the maximum possible score, respectively). Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training.

AB - Objective: To determine the sensitivity to change and minimal clinically important difference (MCID) for the self-administered Locomotor Capabilities Index-5 (LCI-5) in people with lower limb amputation undergoing prosthetic training. Design: Prospective single-group observational study. Methods: The LCI-5 was administered to 110 patients (69 males [63%]; median [interquartile range] age, 60 [48–69] years) before and after prosthetic training. The external anchor administered after the program was a 7-point Global Rating of Change Scale (GRCS) designed to quantify the effect (improvement or deterioration) of the intervention. Results: Test–retest reliability of the LCI-5 (n = 30) was high (intraclass correlation coefficient [ICC 2,1 ] = 0.92). The minimum detectable change at the 95% confidence level was 5.66 points. After triangulating these results with those of the mean-change approach and receiver operating characteristic (ROC) curve analysis (area under the ROC curve ≥ 0.90), based on a different GRCS score splitting, we identified 2 cutoffs for the LCI-5: a change of 7 points, indicating the MCID, and 12 points, indicating “large improvement” in locomotor capabilities (12.5% and 21.4% of the maximum possible score, respectively). Conclusions: The LCI-5 showed a high ability to detect change over time (responsiveness). The 2 proposed values (MCID of 7 points and large improvement of 12 points), based on a mix of distribution- and anchor-based approaches, represent cutoffs that can accurately identify 2 different levels of true change (as perceived by the patient) in locomotor capability after prosthetic training.

KW - Leg prosthesis

KW - Lower-limb amputation

KW - Outcome assessment

KW - Prosthetic training

KW - Psychometrics

KW - Rehabilitation

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SN - 1877-0657

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