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Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation

LV Iyer, PT, MS, is Staff Physical Therapist, Warbasse Nursery School, Brooklyn, NY. She was a student in the Post-Professional Graduate Program in Physical Therapy, MGH Institute of Health Professions, Boston, Mass, when this study was conducted
SM Haley, PT, PhD, is Director of Center of Rehabilitation Effectiveness and Associate Professor of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA) (smhaley{at}bu.edu).
MP Watkins, PT, DPT, is Professor, MGH Institute of Health Professions
HM Dumas, PT, MS, is Manager, The Research Center for Children With Special Health Care Needs, Franciscan Children's Hospital & Rehabilitation Center, Boston, Mass

Address all correspondence to Dr Haley

Background and Purpose. Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. Subjects and Methods. A retrospective review was done of the medical charts of 53 children and youth (1–19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. Results. The MCIDs ranged from 6 to 15 points (=11.5, 95% confidence interval=±2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (=.73–.80). Discussion and Conclusion. Across all scales, PEDI change scores on the order of about 11% (0–100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Key Words: Clinical importance • Minimal clinically important difference • Pediatric Evaluation of Disability Inventory • Responsiveness

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