{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:27:01Z","timestamp":1791649621166,"version":"4.3.4"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T00:00:00Z","timestamp":1602720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The importance of knee sagittal kinematic parameters, as a predictor of walking performance in post-stroke gait has been emphasised by numerous researchers. However, no studies so far were designed to determine the minimal clinically important differences (MCID), i.e., the smallest difference in the relevant score for the kinematic gait parameters, which are perceived as beneficial for patients with stroke. Studies focusing on clinically important difference are useful because they can identify the clinical relevance of changes in the scores. The purpose of the study was to estimate the MCID for knee range of motion (ROM) in the sagittal plane for the affected and unaffected side at a chronic stage post-stroke. Fifty individuals were identified in a database of a rehabilitation clinic. We estimated MCID values using: an anchor-based method, distribution-based method, linear regression analysis and specification of the receiver operating characteristic (ROC) curve. In the anchor-based study, the mean change in knee flexion\/extension ROM for the affected\/unaffected side in the MCID group amounted to 8.48\u00b0\/6.81\u00b0 (the first MCID estimate). In the distribution-based study, the standard error of measurement for the no-change group was 1.86\u00b0\/5.63\u00b0 (the second MCID estimate). Method 3 analyses showed 7.71\u00b0\/4.66\u00b0 change in the ROM corresponding to 1.85-point change in the Barthel Index. The best cut-off point, determined with ROC curve, was the value corresponding to 3.9\u00b0\/3.8\u00b0 of change in the knee sagittal ROM for the affected\/unaffected side (the fourth MCID estimate). We have determined that, in chronic stroke, MCID estimates of knee sagittal ROM for the affected side amount to 8.48\u00b0 and for the unaffected side to 6.81\u00b0. These findings will assist clinicians and researchers in interpreting the significance of changes observed in kinematic sagittal plane parameters of the knee. The data are part of the following clinical trial: Australian New Zealand Clinical Trials Registry: ACTRN12617000436370<\/jats:p>","DOI":"10.3390\/jcm9103305","type":"journal-article","created":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T05:45:51Z","timestamp":1602913551000},"page":"3305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-4383","authenticated-orcid":false,"given":"Agnieszka","family":"Guzik","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzesz\u00f3w, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4511-8419","authenticated-orcid":false,"given":"Mariusz","family":"Dru\u017cbicki","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzesz\u00f3w, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"And\u017celina","family":"Wolan-Nieroda","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzesz\u00f3w, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1609-8060","authenticated-orcid":false,"given":"Andrea","family":"Turolla","sequence":"additional","affiliation":[{"name":"Laboratory of Kinematics and Robotics IRCCS San Camillo Hospital, 30126 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5990-5734","authenticated-orcid":false,"given":"Pawel","family":"Kiper","sequence":"additional","affiliation":[{"name":"Azienda ULSS 3 Serenissima Physical Medicine and Rehabilitation Unit, 30126 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/nhs.12234","article-title":"Gait velocity and walking distance to predict community walking after stroke","volume":"17","author":"An","year":"2015","journal-title":"Nurs. Health Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.3109\/09638288.2012.680649","article-title":"Walking tests for stroke survivors: A systematic review of their measurement properties","volume":"34","year":"2012","journal-title":"Disabil. Rehabil."},{"key":"ref_3","first-page":"103","article-title":"Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke","volume":"42","author":"Kosak","year":"2005","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1310\/tsr2103-197","article-title":"Clinimetric properties of the Timed Up and Go Test for patients with stroke: A systematic review","volume":"21","author":"Rensink","year":"2014","journal-title":"Top. Stroke. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/10749357.2017.1285746","article-title":"A systematic review of mechanisms of gait speed change post-stroke. Part 1: Spatiotemporal parameters and asymmetry ratios","volume":"24","author":"Wonsetler","year":"2017","journal-title":"Top. Stroke Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.gaitpost.2011.11.030","article-title":"Temporal gait symmetry and velocity differ in their relationship to age","volume":"35","author":"Patterson","year":"2012","journal-title":"Gait Posture"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.nurx.2006.07.009","article-title":"Issues in selecting outcome measures to assess functional recovery after stroke","volume":"3","author":"Barak","year":"2006","journal-title":"NeuroRx"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/0197-2456(89)90005-6","article-title":"Measurement of health status. Ascertaining the minimal clinically important difference","volume":"10","author":"Jaeschke","year":"1989","journal-title":"Control Clin. Trials"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1589\/jpts.25.1223","article-title":"Minimal clinically important difference for comfortable speed as a measure of gait performance in patients undergoing inpatient rehabilitation after stroke","volume":"25","author":"Bohannon","year":"2013","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S163","DOI":"10.1161\/CIRCOUTCOMES.115.002098","article-title":"Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations","volume":"8","author":"Bushnell","year":"2015","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/NPT.0000000000000236","article-title":"Minimal Clinically Important Difference of the 6-Minute Walk Test in People with Stroke","volume":"42","author":"Fulk","year":"2018","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.gaitpost.2009.05.020","article-title":"The gait profile score and movement analysis profile","volume":"30","author":"Baker","year":"2009","journal-title":"Gait Posture"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"718423","DOI":"10.1155\/2013\/718423","article-title":"Recent Advances in Computational Mechanics of the Human Knee Joint","volume":"2013","author":"Kazemi","year":"2013","journal-title":"Comput. Math. Methods. Med."},{"key":"ref_14","unstructured":"Reicher, M., and Bochenek, A. (2008). Human Anathomy. General Anatomy. Bones, Joints and Ligaments, PZWL Press."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1161\/01.STR.26.6.982","article-title":"Classification of walking handicap in the stroke population","volume":"26","author":"Perry","year":"1995","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.gaitpost.2008.09.003","article-title":"The reliability of three-dimensional kinematic gait measurements: A systematic review","volume":"29","author":"McGinley","year":"2009","journal-title":"Gait Posture"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.pmr.2012.11.007","article-title":"Gait analysis for poststroke rehabilitation: The relevance of biomechanical analysis and the impact of gait speed","volume":"24","author":"Nadeau","year":"2013","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Boudarham, J., Roche, N., Pradon, D., Bonnyaud, C., Bensmail, D., and Zory, R. (2013). Variations in kinematics during clinical gait analysis in stroke patients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0066421"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pri.528","article-title":"The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients","volume":"17","author":"Cooper","year":"2012","journal-title":"Physiother. Res. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gaitpost.2009.04.010","article-title":"Gait classification in post-stroke patients using artificial neural networks","volume":"30","author":"Kaczmarczyk","year":"2009","journal-title":"Gait Posture"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1589\/jpts.26.483","article-title":"Study on the usefulness of sit to stand training in self-directed treatment of stroke patients","volume":"26","author":"Mun","year":"2014","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.neucli.2015.09.005","article-title":"Gait post-stroke: Pathophysiology and rehabilitation strategies","volume":"45","author":"Beyaert","year":"2015","journal-title":"Neurophysiol. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.2106\/00004623-199610000-00008","article-title":"Gait pattern in the early recovery period after stroke","volume":"78","author":"Simon","year":"1996","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.gaitpost.2003.07.002","article-title":"Magnitude and pattern of 3D kinematic and kinetic gait profiles in persons with stroke: Relationship to walking speed","volume":"20","author":"Kim","year":"2004","journal-title":"Gait Posture"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S0966-6362(02)00165-0","article-title":"Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke","volume":"18","author":"Mulroy","year":"2003","journal-title":"Gait Posture"},{"key":"ref_26","first-page":"309","article-title":"Work and power in gait of stroke patients","volume":"72","author":"Olney","year":"1991","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.gaitpost.2007.03.008","article-title":"Gait pattern categorization of stroke participants with equinus deformity of the foot","volume":"27","author":"Kinsella","year":"2008","journal-title":"Gait Posture"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1093\/ptj\/78.8.814","article-title":"Multivariate examination of data from gait analysis of persons with stroke","volume":"78","author":"Olney","year":"1998","journal-title":"Phys. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0167-9457(91)90046-Z","article-title":"A gait analysis data collection and reduction technique","volume":"10","author":"Davis","year":"1991","journal-title":"Hum. Mov. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3109\/09638288809164103","article-title":"The Barthel ADL Index: A reliability study","volume":"10","author":"Collin","year":"1998","journal-title":"Int. Disabil. Stud."},{"key":"ref_31","first-page":"526","article-title":"Psychometric characteristics of the Barthel Activities of Daily Living Index in stroke patients","volume":"100","author":"Hsueh","year":"2001","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/1545968306294729","article-title":"Establishing the minimal clinically important difference of the Barthel Index in stroke patients","volume":"21","author":"Hsieh","year":"2007","journal-title":"Neurorehabil. Neural. Repair."},{"key":"ref_33","first-page":"400","article-title":"Looking for important change\/differences in studies of responsiveness. OMERACT MCID Working Group. Outcome Measures in Rheumatology. Minimal Clinically Important Difference","volume":"28","author":"Beaton","year":"2001","journal-title":"J. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s00586-002-0464-0","article-title":"The clinical importance of changes in outcome scores after treatment for chronic low back pain","volume":"12","author":"Hagg","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF00435226","article-title":"Interpretation of quality of life changes","volume":"2","author":"Lydick","year":"1993","journal-title":"Qual. Life Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1081\/BIP-120028508","article-title":"Minimal important difference thresholds and the standard error of measurement: Is there a connection?","volume":"14","author":"Wyrwich","year":"2004","journal-title":"J. Biopharm. Stat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0895-4356(03)00044-1","article-title":"Defining clinically meaningful change in health-related quality of life","volume":"56","author":"Crosby","year":"2003","journal-title":"J. Clin. Epidemiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Friedman, J. (2009). The Elements of Statistical Learning: Data Mining, Inference, and Prediction, Springer Press.","DOI":"10.1007\/978-0-387-84858-7"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hoffman, J.I.E. (2015). Variations Based on Linear Regression, in Biostatistics for Medical and Biomedical Practitioners, Academic Press.","DOI":"10.1016\/B978-0-12-802387-7.00028-7"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.apmr.2005.08.130","article-title":"Determination of the minimal clinically important difference in the FIM instrument in patients with stroke","volume":"87","author":"Beninato","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1093\/ptj\/76.10.1109","article-title":"Health status measures: Strategies and analytic methods for assessing change scores","volume":"76","author":"Stratford","year":"1996","journal-title":"Phys. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"109575","DOI":"10.1016\/j.jbiomech.2019.109575","article-title":"Application of the Gait Deviation Index in the analysis of post-stroke hemiparetic gait","volume":"99","author":"Guzik","year":"2020","journal-title":"J. Biomech."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1590\/S0100-879X2012007500051","article-title":"Three-dimensional kinematic analysis of upper and lower limb motion during gait of post-stroke patients","volume":"45","author":"Carmo","year":"2012","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4859","DOI":"10.12659\/MSM.898420","article-title":"Changes in Gait Symmetry After Training on a Treadmill with Biofeedback in Chronic Stroke Patients: A 6-Month Follow-Up from a Randomized Controlled Trial","volume":"22","author":"Guzik","year":"2016","journal-title":"Med. Sci. Monit."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0028-3908(00)00003-4","article-title":"Defining post-stroke recovery: Implications for design and interpretation of drug trials","volume":"39","author":"Duncan","year":"2000","journal-title":"Neuropharmacology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/MRR.0000000000000108","article-title":"Six-month functional recovery of stroke patients: A multi-time-point study","volume":"38","author":"Lee","year":"2015","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_47","first-page":"9708905","article-title":"Brain Functional Reserve in the Context of Neuroplasticity after Stroke","volume":"2019","author":"Czajka","year":"2019","journal-title":"Neural. Plast."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1097\/00001756-199903170-00026","article-title":"Plasticity in the motor system related to therapy-induced improvement of movement after stroke","volume":"10","author":"Kopp","year":"1990","journal-title":"Neuroreport"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3305\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:21:28Z","timestamp":1760178088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,15]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["jcm9103305"],"URL":"https:\/\/doi.org\/10.3390\/jcm9103305","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,15]]}}}