Policy for controlling pain after surgery: effect of sequential changes in management.

TLDR

The Pediatric Evaluation of Disability Inventory (PEDI) quantifies functional changes in pediatric rehabilitation but does not provide client‑specific information on clinically meaningful improvements. This study aimed to determine the minimal clinically important difference (MCID) in PEDI scores that clinicians consider meaningful during inpatient rehabilitation. A retrospective review of 53 children’s charts was conducted, and 15 clinicians masked to PEDI scores rated functional changes using Likert and VAS scales, which were then collapsed into four categories—including the MCID—and compared with PEDI change scores. The MCID for PEDI scales ranged from 6 to 15 points (mean 11.5 ± 2.8), with Likert and VAS ratings strongly correlated (τ = 0.73–0.80), indicating that approximately 11 % change on a 0–100 scale is clinically meaningful to clinicians.

Abstract

<b>Background and Purpose.</b> 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. <b>Subjects and Methods.</b> 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. <b>Results.</b> The MCIDs ranged from 6 to 15 points (X̄=11.5, 95% confidence interval=±2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (τ=.73–.80). <b>Discussion and Conclusion.</b> Across all scales, PEDI change scores on the order of about 11% (0–100 scale) appear to be meaningful to clinicians during a child9s or adolescent9s 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.