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Hi! I had a question about this question from Case 9 (SCI) and MCD vs MCID measures:
Q: Upon reassessment after three months of outpatient physical therapy, the patient ambulates 720 feet with bilateral forearm crutches and ankle-foot orthoses during the Six-Minute Walk Test. Which of the following is the best goal for Six-Minute Walk Test distance within the next three months?
It says the answer is 870 ft because “According to Lam et al., the minimal detectable change on the Six-Minute Walk Test for individuals with spinal cord injury is 150 feet. An improvement by this distance would ensure a statistically significant improvement in distance walked.”
I calculated that to get the MCID of a change of 0.1m/s, he would need to walk 0.70m/s during the 6MWT which would equate to 252m or 826 ft which is obviously different than the MCD answer of 870ft. I think I’m just confused on when to use MCD vs MCID for patient outcomes and which numbers are more important to memorize for the exam in general? Should we always use the MDC and not the MCID when writing goals? If so, then when would we need to know the MCID?
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Hi Kelsey,
MCID and MDC are different things that serve different purposes. Often, both are not available for a specific test. If both are available, I tend to favor the MCID because it inherently has clinical significance versus the MDC that is purely a statistical measure.More importantly for this question, you want to make sure you are comparing apples to apples. A significant change measure for gait speed (usually the 10MWT) does not necessarily apply to a significant change on a different test (the Six-Minute Walk Test). You’ll want to use significant values for the 6MWT for goal setting for the 6MWT. Similarly, you’ll want to apply significant values for the 10MWT to goal setting for the 10MWT.
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How important is it for us to memorize the MCID and the MCD for the NCS? I use them in setting goals but have not memorized them for the test. I feel it is more important at this time to make sure I know all the cut-off scores.
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My recommendation is to have a general idea of significant values for the big outcome measures (like the Core Outcomes). For example, for the FGA, I’d know that <23/30 is the falls risk cut-off and 4-6 points represents a meaningful change.
I wouldn't try to memorize everything for all the outcome measures. You should be in good shape if you can generally interpret how a patient is doing by looking at the scores.
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