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Application of the six-minute walk test in populations with neuromuscular and musculosketetal conditions : a methodologic perspective

University of British Columbia

Rationale: Over the past decade, the six-minute walk (SMW) test has been increasingly used as an assessment tool and treatment outcome measure in populations with neuromuscular and musculoskeletal conditions. Recently, the validity of the test has been called into question. Contamination of the test results with uncontrolled extraneous variables due to an apparent lack of standardization in the administration of the test, and lack of monitoring, recording, and reporting of these variables, may lead to major discrepancies in the test results, thereby limiting optimal clinical decision making, and the interpretability of the test results in research. Purposes: 1) To review systematically the application of the SMW test in research studies on individuals with neuromuscular and musculoskeletal conditions from a methodological perspective, 2) To examine common clinical measures that may influence walk performance in the SMW test in people with chronic poliomyelitis, and to examine the test-retest reliability of the SMW distance, lower extremity muscle strength, balance, and balance confidence on separate trials in the same cohort, and 3) To formulate guidelines for conducting the test to meet the special needs of patients with neuromuscular and musculoskeletal conditions. Results: 1) Sixty-five studies were included in the systematic review. Of these, 25 used the test as an assessment tool, and 40 as a treatment outcome measure. There was marked variability in the administration of the SMW test across studies. 2) The SMW distance correlated with physiological cost index (PCI), pre test pain, lower extremity muscle strength, balance, balance confidence, corrected leg length discrepancy, and lung function, but not with rate pressure product, ratings of perceived exertion, post test pain, pre and post test fatigue. The PCI correlated with balance confidence and lung function. About 68% of variance in SMW distance was accounted for by balance and pre-test pain. 3) Clinical practice guidelines for the SMW test were extended. Conclusion: Based on tightened guidelines of the SMW test for patients with chronic poliomyelitis, walking may be improved by optimizing balance and controlling pain. We propose that these guidelines be adopted universally and applied systematically across clinical and research applications for patients with neuromuscular/musculoskeletal, as well as cardiovascular/cardiopulmonary conditions.

Thesis/Dissertation

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2009-11-02

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http://hdl.handle.net/2429/14599

Rehabilitation Sciences

University of British Columbia

UBCV

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