Responsiveness and Minimal Clinically Important Difference of the Capabilities of Upper Extremity Test
1Marino R, 1Sinko R, 1Leiby B, 2Bryden A, 3Nemunaitis G, 4Chen D, 5Backus D
1Thomas Jefferson University, Philadelphia, PA, USA; 2Case Western Reserve University, Cleveland, OH, USA; 3MetroHealth Medical Center, Cleveland, OH, USA; 4Shirley Ryan AbilityLab, Chicago, IL, USA; 5Shepherd Center, Atlanta, GA, USA
Objective: To determine the responsiveness and minimal clinically important difference (MCID) of the Capabilities of Upper Extremity Test (CUE-T) in patients with cervical spinal cord injury (SCI).
Design/Method: Subjects included 69 persons (57male/12female) with cervical SCI; 60 had acute injuries recruited during inpatient rehabilitation; 9 had chronic injuries receiving therapy including upper extremity functional electrical stimulation (FES) for exercise. Subjects were assessed during inpatient rehabilitation (acute) or prior to the start of FES (chronic) and 3 months later using the CUE-T, upper extremity motor scores (UEMS), and self-care subscale of Spinal Cord Independence Measure (SC-SCIM). At the second assessment subjects rated their global impression of change in UE function on a scale from -7 to +7. The standardized response mean (SRM), average change divided by standard deviation of change was determined. MCID was estimated using the subjective change rating and also change in UEMS and SC-SCIM.
Results: Subjects were 41.9 ± 18.1 years old; neurological levels ranged from C1 through C7; 25 were motor complete and 44 motor incomplete. For acute subjects, the mean change in CUE-T was 14.8±13.8 points, for UEMS was 6.4±5.5 points and for SC-SCIM was 4.9±4.7 points. All changes were significant at p<.001 (t-test). The SRM for acute subjects was 1.0 for CUE-T, 1.2 for UEMS and 0.9 for SC-SCIM. Subjects who rated subjective improvement as < 2 points (no change), 2-3 points (small) or 4-7 points (large), had changes in CUE-T of 2.3±4.4, 11.7±7.3, and 15.8±14.4 points respectively. Subjects who improved on SC-SCIM < 2 points (no change), 2-5 points (small) or > 5 points (large) had respective changes in CUE-T of 5.8±5.8, 14.4±7.4, and 20.1±17.8 points. Based on UEMS gains of < 3 points (no change), 3-6 points (small) or > 6 points (large), corresponding changes in CUE-T were 6.2±6.7, 11.9±10.0, and 20.7±15.9 points.
Similar results were seen for change by side: subjects who reported no vs small improvement had changes in right side CUE-T scores of 2.9±5.5 vs. 7.0±6.9 points and left side scores of 3.8±6.4 vs. 5.3±3.3 points. Based on UEMS, subjects who gained < 1 point on a side (no change vs 2-3 points (small) had corresponding CUE-T scores of 2.8±4.1 and 7.8±6.0 points on the right and 2.6±3.7 and 4.9±5.5 points on the left.
Conclusion: The CUE-T is responsive to change in persons with acute cervical SCI with a large SRM. Similar values for MCID were found using subjective and objective anchors. We estimate that the MCID is 12 points for the total CUE-T and 6 points for either side.
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