established [9, 10, 184]. However, it is not known whether a change in post-stroke gait

velocity is "clinically meaningful", as reflected by improved functional abilities such as

activity and participation. A clinically meaningful change is important to determine as it

is related to patient-valued benefits. Barrett et al. discussed the need to observe a

clinically "important difference" by merging patient-oriented and evidence-based

frameworks together [7]. Such clinical meaningfulness can be seen by examining the

sufficiently important difference (SID), the smallest amount of patient-valued benefit

required from an intervention to justify associated costs, risks, and other harms. Lord and

Rochester recently stated a need for a conceptual framework related to post-stroke

mobility and that there is "no guarantee that increases in gait velocity will denote a

meaningful improvement in performance" [211]. The objective of this study was to

determine whether a change in gait speed over three months was clinically meaningful as

reflected by the impact on ADLs (including mobility), instrumental activities of daily

living (IADLs), and social participation after stroke.

 Methods

Design

 Data in this study are derived from a parent study; a prospective, randomized,

controlled, single-blind, clinical intervention trial [8]. The trial was completed to

determine the effects of a therapist-supervised 12-14 week home-based, structured, and

progressive exercise intervention on participants post-stroke. The intervention focused on

upper and lower-limb strength, balance, endurance, and increased use of the affected

extremities. The intervention group was compared to a usual care group who received

rehabilitation as prescribed by their physician and bi-weekly visits from research staff

Informed consent was received from all participants through methods approved by the