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Rehab Measures: 6 Minute Walk Test

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6 Minute Walk Test Instructions (other languages available below) 

Title of Assessment

6 Minute Walk Test  

Acronym

6MWT

Instrument Reviewer(s)

Initially reviewed by Jason Raad, MS and Rachel Tappan PT, NCS in 2010; Updated with references for the SCI and PD populations by Lars Petersen, SPT and Shawn White, SPT in 2011; Updated by candy Tefertiller PT, DPT, ATP, NCS and Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references for the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA; Updated with references for Osteoarthritis, Stroke, and Alzheimer's Disease by Kevin Pelczarski, SPT, Melissa Potts, SPT, and Brittany Brown, SPT in 10/2012; Updated with references for the PD population by Jeffrey Hoder, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013.

Summary Date

4/26/2013 

Purpose

Assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance

Description

  • Walk of cover as far a distance as possible over 6 minutes
  • Documentation should include the speed tested if fastest speed is not used (preferred vs. fast)
  • Assistive devices can be used but kept consistent from test to test
  • Individual should be able to ambulate without physical assistance

Area of Assessment

Aerobic Capacity; Gait 

Body Part

Not Applicable 

ICF Domain

Activity 

Domain

Motor 

Assessment Type

Observer 

Length of Test

06 to 30 Minutes 

Time to Administer

6 minutes

Number of Items

Not Applicable 

Equipment Required

  • Stop watch
  • Measuring wheel to measure distance (recommended)

Training Required

No training required

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

Preschool Child: 2-5 years; Child: 6-12 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Arthritis; Fibromyalgia; Geriatrics; Multiple Sclerosis; Parkinson’s Disease; Spinal Cord Injury; Stroke 

Populations Tested

  • Alzheimer's Disease
  • Children Fibromyalgia
  • Geriatrics
  • Heart failure
  • Multiple sclerosis
  • Parkinson’s Disease
  • Pulmonary disease
  • Osteoarthritis
  • Spinal cord injury
  • Stroke

Standard Error of Measurement (SEM)

Alzheimer’s Disease:

(Ries et al, 2009; n = 20; mean age = 81.05 (9.48) years; mild to moderate AD; n = 31; mean age = 80.48 (8.43); moderately severe to severe AD, Alzheimer’s Disease)

  • SEM for mild to moderate AD = 21.86 meters
  • SEM for moderately severe to severe AD = 19.57 meters

Geriatrics and Stroke:

(Perera et al, 2006; Strength training trial: n = 100 older adults with mobility disabilities; mean age = 77.6 (7.6) years; Intervention trial: n = 100 geriatrics w/ mild to moderate mobility limitations and stroke; mean time since stroke onset 76 (28) days; mean age = 69.8 (10.3) years, Geriatrics and Stroke)

  • SEM for strenth training trial = 21 meters
  • SEM for interventional trial = 22 meters

Osteoarthritis:

(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)

  • SEM = 26.29 meters

SCI:

(van Hedel et al, 2005; n = 22 SCI patients assessed within the first month injury and reassessed at 3, 6, and 12 months; mean age = 45.5 (16.7) years; WISCI II score > 0; quoted from Lam et al; 2008, Acure SCI)

  • SEM = 16.5 meters (54 feet)

(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)

  • SEM = 16.5 meters (54.13 feet)

Stroke:

(Eng et al, 2004; n = 12; mean age = 62.5 (8.6) years; mean time since stroke onset = 3.5 (2.0) years, moderate motor deficits, Chronic Stroke)

SEM=12.4 meters (40.68 feet)

 

(Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years; mean time since stroke onset 16 (5) months for males; 18 (5) months for females, Chronic Stroke)

  • 18.6 meters (61 feet) or 4.8% change

(Wevers et al, 2011; n = 27 patients discharged home from an inpatient rehabilitation center after stroke, in the Functional Ambulation category; tested outdoors with both GPS and a measuring wheel; mean age = 60.7 (10.9) years; mean time since stroke onset = 266 (38) days, Chronic Stroke)

  • SEM = 11.9 meters for measuring wheel (outdoors)
  • SEM = 18.1 meters for GPS (outdoors)

Minimal Detectable Change (MDC)

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer’s Disease)

  • MDC = 33.47 meters

COPD:

(Redelmeier et al, 1997; n = 112 patients with COPD; mean age = 67 years; mean FEV1 = 975 ml, COPD)

  • MDC = 54 meters (177 feet)

Geriatrics:

(Perera et al, 2006, Geriatrics)

  • MDC (calculated from SEM) = 58.21 meters (190.98 feet)

Osteoarthritis:

(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)

  • MDC = 61.34 meters

Parkinsonism:

(Steffen and Seney, 2008; n = 37 community-dwelling older adults with Parkinsonism, mean age = 71 (12) years; mean Hoehn & Yahr Stage of 2, Parkinsonism)

  • MDC = 82 meters (269 feet)

SCI:

(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)

  • MDC = 45.8 meters (150 feet) or a 22% change

Stroke:

(Eng et al, 2004, Chronic Stroke)

  • MDC (Calculated from SEM) = 34.37 meters (112.76 feet)

(Flansbjer et al, 2005, Chronic Stroke)

  • MDC = 36.6 meters (120 feet) or a 13% change

(Perera et al, 2006, Subacute Stroke)

  • MDC (Calculated from SEM) = 60.98 meters (200.01 feet)

Minimally Clinically Important Difference (MCID)

COPD:

(Rasekaba et al, 2009; review article, COPD)

  • MCID = 54 meters

Geriatrics and Stroke:

(Perera et al, 2006, Geriatrics and Stroke)

  • MCID = 50 meters

Spinal Cord Injury:

(Forrrest et al, 2014; n = 249 patients enrolled in standardized Locomotor Training therapy programs that were admitted between February 2008 and April 2011; patients were evaulated at 7 out-patient clinical sites; mean age = 42 (16) years; AIS C = 20, D = 179, Not Evaluated = 50; mean time since SCI = 0.7 years)

  • Overall MCID = 0.10 m/s
  • Slow MCID = 0.11 m/s
  • Fast MCID = N/A: among fast walkers, the 6MWT did not significantly correspond with clinically relevant change and reliable MCID could not be calculated

Cut-Off Scores

Not Established

Normative Data

Alzheimer's Disease:

(Tappen et al, 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)

  • Mean Mini-Mental State Exam Score = 9.3 (6.0)
  • Mean Length of Stay: 822

Chronic Heart Failure:

(Rasekaba et al, 2009, Chronic Heart Failure)

  • Average distance walked: 310-427 meters depending on the severity of heart disease
  • Distance has in inverse correlation with the New York Heart Association (NYHA) functional class
  • Ranging from 502-743 meters depending on age, sex, height, weight, predicted heart rate max

Average distance of 238-388 meters for subjects with COPD

 

COPD:

(Casanova et al, 2007; Szekely et al, 1997, COPD)

  • Average distance walked: 380 m (range 160-600 m)
  • Distance < 200 m is predictive of hospitalization or mortality
  • Significant decline in 6MWD demonstrated in healthy adults as age increases
  • Geographic variations also noted in 6MWD

(Szekely et al, 1997, COPD)

  • Inability to walk > 200m before the operation and resting PzCO2 > 45 were the best predictors of unacceptable postoperative outcome
  • Distance < 200m is predictive of hospitalization or mortality

Community-dwelling Elderly:

(Steffen et al, 2002; n = 96; community dwelling elderly people with independent function who were nonsmokers with no history of dizziness; > 60 yo and did not use assistive devices, Community-dwelling Elderly)

 

Mean Distance in Meters by Age & Gender

Age

Male

Female

60-69 yrs

572 m

538 m

70-79 yrs

527 m

471 m

80-89 yrs

417 m

392 m

 

Healthy Adults:

(Enright el al, 1998, Healthy Adults)

  • Gender specific regression equations can be used to explain 40% of the variance in distance walked
  • 6MWD significantly less for men and women who are heavier, older and for shorter men

Modified 6MWT:

(Geiger et al, 2007; n = 528 children between 3 and 18 years old, Modified 6MWT)

 

Modified 6MWT Distance in Children

Age

Male

Female

3-5 yrs

536.5 (95.6)

501.9 (90.2)

6-8 yrs

577.8 (56.1)

573.2 (69.2)

9-11 yrs

672.8 (61.6)

661.9 (56.7)

12-15 yrs

697.8 (74.7)

663.0 (50.8)

16-18 yrs

725.8 (61.2)

664.3 (49.5)



Healthy Adults:

(Enright el al, 1998, Healthy Adults)

  • Gender specific regression equations can be used to explain 40% of the variance in distance walked
  • 6MWD significantly less for men and women who are heavier, older and for shorter men

SCI:

(Barbeau et al, 2007; n = 107, AIS-C and D; n = 38; with lesions between C-5 and L-3, tested at 3, 6 and 12 months post-injury, Acute SCI)

Comparison of Walking Speed Within Subjects With Upper Motor Neuron Lesions During the SCILT:

Months after entry to trial

n

Walking Speed (m/s) over 6 minutes

Walking Speed (m/s) over 15.2m

p value

3

66

0.64 (0.06)

0.72 (0.05)

0.14

6

69

0.79 (0.05)

0.92 (0.06)

0.29

12

70

0.88 (0.06)

1.08 (0.06)

0.001

*Gait speed was very similar at 3 and 6 month testing between 15.2 m and 6 minute walking tests; however, gait speed was significantly faster during the shorter distance test at 12 month follow up.

Comparison of Walking Speed by the slowest, middle and fastest patients in each data collection at end of therapy: 3 months

Variable

n

Quartile

Walking Speed (m/s) over 15.2 m

p value

15.2 m

6 minute

14

Lower

0.02 (0.06)

0.16 (0.06)

0.15

15.2 m

6 minute

33

Middle

0.74 (0.05)

0.62 (0.29)

0.07

15.2 m

6 minute

19

Upper

1.55 (0.06)

1.33 (0.41)

0.01

**No statistical difference noted in gait speed between the two measures for the lower and middle quartile subject when stratified by walking speed; However, a statistical difference was found for individuals who achieved community walking speeds (> 0.8 m/s - 1.0 m/s) in the 15.2 m walking test upon completion of the 3 month treatment intervention as well as 12 month follow up.

(Olmos et al, 2008; n = 18; all participants were AIS D; tested three times each with a 60 minute interval between test run, in a Physical Therapy gym versus in a community environment, Chronic SCI)

  • Statistically significant improvement found when individuals completed 6MWT in community environment vs. physical therapy gym (p < 0.01)

Six-Minute Walking Test (m)

6MWT Gym

6MWT Community

Mean

382.39

401.44

Median

371.75

367.80

SD

120.988

130.276

Min

151

151

Max

560

584

 

Stroke:

(Wevers et al, 2011, Chronic Stroke)

6MWT Outcome (n=27)
Variable
Mean (SD)
Range
GPS 1st Measurement, m
408 (132)
133-700
GPS 2nd Measurement, m 417 (139) 127-695
MW 1st Measurement, m
413 (127)
129-664
MW 2nd Measurement, m
422 (132)
125-668
6MWT: six-minute walk test; GPS: global positioning system; MW: measuring wheel; SD: standard deviation

Test-retest Reliability

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer’s disease)

  • Excellent test-retest reliability for all participants (ICC = 0.982-0.987)

Geriatrics:

(Harada et al, 1999; n = 86; mean age = 75 (6) years, Geriatrics)

  • Excellent test-retest reliability (r = 0.95)

(Steffen et al, 2002, Geriatrics)

  • Excellent test-retest reliability (ICC = 0.95)

Osteoarthritis:

(Kennedy et al, 2005, Osteoarthritis)

  • Excellent test-retest reliability (ICC = 0.94)

Stroke:

(Eng et al, 2004; n = 12 community-dwelling individuals who had a stroke with moderate motor deficits; mean time since stroke onset = 3.5 (2.0) years; mean age = 62.5 (8.6) years, Chronic Stroke)

  • Excellent test-retest reliability (ICC = 0.99 distance in meters)
  • Excellent test-retest reliability for VO2 (ICC = 0.99)

(Flansbjer et al, 2005, Chronic Stroke)

  • Excellent Test-retest reliability (ICC = 0.99)

(Fulk et al, 2008; n = 35 patients who are enrolled in inpatient rehabilitation after stroke; mean age = 67.4 (13.8) years; mean time since stroke onset = 34.5 (17.7) days, Acute Stroke)

  • Excellent test-retest reliability for all participants (ICC = 0.862)
  • Excellent test-retest reliability for those who require physical assistance to walk (ICC = 0.97)
  • Excellent test-retest reliability for those who can walk without assistance (ICC = 0.80)
  • Excellent test-retest reliability for those require an assistive device to walk (ICC = 0.914)

(Wevers et al, 2011, Chronic Stroke)

  • Excellent test-retest reliability between first and second 6MWTs outdoors (ICC = 0.96 for GPS and 0.98 for measuring wheel)

TBI:

(Mossberg, 2003, n = 23; mean age 35.5 (12.5) years male, 30.5 (12.8) years female; approximately 12 months since injury, TBI)

  • Excellent test re-test reliability (ICC = 0.94)

(VanLoo et al, 2004, n = 13; mean age = 32.5 (11.3) years; average time post injury 11.9 (15.7) months; mean initial GCS 5.8 (2.9); mean PTA 43.8 (39.1) days, TBI)

  • Excellent test re-test reliability (ICC = 0.96)

Parkinson's Disease:

(Steffen et al, 2008)

  • Excellent test retest reliability (ICC = 0.95 - 0.96)

 

Interrater/Intrarater Reliability

Alzheimer’s Disease:

(Tappen et al. 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)

  • Excellent interrater reliability (ICC = 0.97 - 0.99)
  • Excellent intrarater reliability (ICC = 0.76 - 0.9)

SCI:

(Scivoletto et al, 2011; n = 37; median age = 58.5 (range 19–77) years; median time from onset = 24 (range 6–109) months; AIS D = 35, C = 2; Median; WISCI = 16, Chronic SCI)

  • Excellent Inter-rater reliability (ICC = 0.99)
  • Excellent Intra-rater reliability (ICC = 0.99)

(van Hedel et al, 2005; n = 22; AIS-A = 1, B = 0, C = 3, D = 18; mean age = 52 (20) years)

Tested on 3 occasions within 7 days:

  • Excellent inter-rater reliability (r = 0.97)

Determined by comparing the 2 measurements performed by a single therapist

  • Excellent intra-rater reliability (r = 0.98)
  • Bland Altman plot: Inter-rater reliability > intra-rater reliability and may indicate first test influence over second test

Stroke:

(Kosak & Smith, 2005; n = 18; mean age = 77 (11) years; mean time since stroke onset = 28 (34) day; enrolled in inpatient rehabilitation; mean FIM score at time of admission to inpatient rehabilitation = 68 (17), Acute Stroke)

  • Adequate Intra-rater reliability (ICC = 0.74)
  • Adequate Inter-rater reliability (ICC = 0.78)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

COPD:

(Szekely et al, 1997; n = 47, average age 60.5 (7.5) years, individuals undergoing volume reduction surgery, COPD)

  • Inability to walk > 200m before the operation and resting PzCO2 > 45 were the best predictors of unacceptable postoperative outcome and mortality (specificity = 84%, sensitivity = 82%)
  • Adequate correlation with length of hospital stay:
    • Pre-surgical 6MWT (R = 0.32)
    • Post-surgical 6MWT (R = 0.40)

Elderly:

(Harada et al, 1999; n = 86 older adults without significant disease; 35 were recruited from retirement homes and 57 from community centers; mean age = 75 (6) years, Elderly)

  • Adequate concurrent validity with:
    • Chair stands (r = 0.67)
    • Standing balance (r = 0.52)
    • Gait speed (r = -0.73)

*Distance walked was greater in active older healthy adults than in inactive older healthy adults (p < 0.0001)

 

SCI:

(Lam et al, 2008, SCI)

  • Excellent concurrent validity with: 10 Meter Walk Test (r = -0.95)
  • Adequate concurrent validity with: Timed Up and Go (r = -0.88)
  • Poor concurrent validity with Walking Index for SCI II (r = 0.60)

(van Hedel et al, 2005; n = 75, mean age = 54 (20) years; AIS classifications C and D included, SCI)

  • Excellent concurrent validity with:
    • Timed Up and Go (r = -0.88)
    • 10 Meter Walk Test (r = -0.95)
  • Poor concurrent validity with
    • Walking Index for SCI II in individuals with poor walking abilities (WISCI II 0-10) r = -0.22
  • Excellent concurrent validity with
    • Walking Index for SCI II in individuals with better walking abilities (WISCI II 11-20) r = 0.64
  • Poor concurrent validity with:
    • WISCI II (0-8, 10, 11, 14, 17), dependent walkers (n = 15) (r = 0.21)
  • Excellent concurrent validity with:
    • WISCI II (9, 12, 13, 15, 16, 18-20), independent walkers (n = 45), (r = 0.65)

Stroke:

 (Flansbjer et al, 2005, Chronic Stroke)

  • Excellent concurrent validity with:
    • TUG (r = -0.89)
    • 10 meter comfortable gait speed (r = 0.84)
    • 10 meter fast gait speed (r = 0.94)
    • Stair Climbing Ascend (r = -0.82)
    • Stair Climbing Descend (r = -0.80)

 (Kosak & Smith, 2005, Acute Stroke)

  • Excellent correlation with the:
    • 2 min walk test (r = 0.997)
    • 12 min walk test (r = 0.994)

(Patterson et al, 2007, n = 74, mean age = 64 (10) years; time since stroke onset 48 (59) months; dichotomized based on median speed, Chronic Stroke)

Results indicate that faster walkers had significantly higher (p < 0.02) values on:

  • Berg Balance Scale
  • VO2peak measurements
  • Covered more distance during the 6-minute walk
  • Paretic leg strength
  • Nonparetic leg strength

 (Wevers et al, 2011, Chronic Stroke)

  • Excellent concurrent validity between the first outdoor 6MWT using GPS and the first outdoor 6MWT using the measuring wheel (r = 0.98, p < 0.00)
  • Excellent and between the second outdoor 6MWTs using GPS and the second outdoor 6MWT using the measuring wheel (r = 0.99, p < 0.00)

Construct Validity (Convergent/Discriminant)

Geriatrics:

(Harada et al, 1999, Geriatrics)

  • Adequate correlation with chair stands (r = 0.67), tandem balance (r = 0.52), and gait speed (r = -0.73)
  • Adequate correlation with SF 36 physical function subscale (r = 0.55) and general health perceptions subscale (r = 0.39)
  • Poor correlation with BMI (r = -0.07)

SCI:

(van Hedel et al, 2007; longitudinal study looking at 6min and 10 MWT at 1, 3, and 6 mo post injury, incomplete SCI who were able to ambulate 10m within 3 months post SCI n = 51, 22 tetraplegic, 29 paraplegic. Cross sectional study n = 18 incomplete SCI, acute and chronic range 2wks to 8 years AIS-C or D, utilized middle 10m of 14m walk, Acute/Subacute SCI)

  • Walking speed differed at each time period (1, 3, 6 mo post) but did not differ between the tests
  • Regression analysis performed to look at relationship between the tests at preferred and maximum walking speed
    • Preferred walking speed R2 = 0.87
    • Maximum walking speed R2 = 0.86

(Musselman and Brunton, 2011; n = 32 individuals with incomplete SCI; sex = 24 males, 8 females; mean age = 47.6 (14.2) years, SCI)

  • Adequate correlation between the 6MWT and SCI-FAP (r = -0.59)

(Hedel et al 2006, n = 22, incomplete SCI who could ambulate within the 1st month post SCI, measured at 1 mo, 3 mo, 6 mo, and 12 mo post, middle 10 m of 14 m walk used, Acute to chronic incomplete SCI)

LEMS

WISCI II

10MWT

Within 1 month

6MWT

Adequate r = 0.54**

Excellent r = -0.78*

Excellent r = -0.91*

After 3 months

6MWT

Adequate r = -0.34

Poor r = -0.28

Excellent r = -0.90*

After 6 months

6MWT

Adequate r = -0.49***

Adequate r = -0.36

Excellent r = -0.87*

After 12 months

6MWT

Adequate r = -0.55*

Adequate r = -0.36

Excellent r = -0.86*

* p < 0.001

** p < 0.01

*** p = 0.02

Spearman’s Correlations

Content Validity

SCI:
(Jackson et al, 2008; n = 54 expert raters asked to assess each measure in three categories: valid or useful, useful but requires validation or changes/improvements, not useful or valid for research in SCI, SCI)
 
Expert Evaluations:
Measure
Valid or Useful
Useful but requires validation
Not useful or valid for RESEARCH
Total Votes
10 Meter Walk Test

32 (60%)

20 (38%)

1 (2%)

53

6 Minute Walk Test
19 (37%)
30 (58%)
3 (6%)
52
FIM-L
3 (6%)
18 (36%)
29 (58%)
50
Votes (%)
 
(Scivolleto et al, 2011; n = 37 with mean time of onset 24 months; 32 AIS-D and 2 AIS-C; Assessed 6MWT using a short or long track, SCI)
  • Significant differences (39.1 m) noted between long and short tracks p < 0.001

Face Validity

TBI:

(Moseley et al, 2004, n = 10, mean age 31.9 (14.2) years, mean days post injury = 56.4 (25.5); mean duration of PTA = 26.6 (8.7) days, TBI)

  • Poor to adequate correlation with 10 meter walk test in various environments:
    • Poor correlation when tested in car park of a metropolitan shopping center and inside shopping center: ICC = 0.06, 0.18 respectively
    • Adequate correlation tested in clinical environment: ICC = 0.37

Floor/Ceiling Effects

Not Established

Responsiveness

COPD:

(Casanova et al, 2007, COPD)

  • Demonstrates significant decline in those individuals with severe airflow limitation (FEV1 < 50%)
  • Decline worsened with disease severity

Geriatrics:

(Perera et al, 2006, Geriatrics)

  • Small meaningful change 20 m
  • Substantial meaningful change 50 m

SCI:

(van Hedel et al, 2006, SCI)

  • For individuals with incomplete SCI, the 6MWT was able to detect walking capacity improvements in patients with less ambulatory impairment during the acute and subacute stages of recovery at 3 and 6 months post injury. Similar findings were not demonstrated with the WISCI II or LEMS.
  • Statistically significant responsiveness 1-3 months post injury and 3-6 months post injury with larger effect size noted 1-3 months post injury (found in Lam et al, 2008)
  • For individuals with incomplete SCI, the 6MWT was not able to detect walking capacity improvements between 6 and 12 months post injury.
    • May be a result of this sample having reached normal walking speeds at 6 months post injury (1.39 m/s)

Further study with a larger sample size needs evaluate responsiveness for chronic (> 12 months ) injuries

 

Stroke:

(Kosak & Smith, 2005, Stroke)

  • Over a 3.9 (2) week inpatient rehabilitation stay SRM = 1.52

Professional Association Recommendations

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, TBI EDGE Taskforce are listed below.  These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

HR

HR

HR

SCI EDGE

HR

HR

HR

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

HR

HR

HR

HR

HR

MS EDGE

R

HR

R

HR

NR

TBI EDGE

LS

R

LS

R

NR

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

HR

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

HR

R

LS

NR

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

HR

HR

R

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Is this tool appropriate for use in intervention research studies? (Y/N)

StrokEDGE

Yes

Yes

Yes

SCI EDGE

Yes

Yes

Yes

MS EDGE

Yes

Yes

Yes

TBI EDGE

Yes

Yes

Yes

Considerations

Reference Equations:

6MWD: (Enright et al 1998; n = 290 healthy adults 40-80yo)

  • Gender-specific regression equations explained 40% of the variance in the distance walked in healthy adults:
  • Men: 6MWD = (7.57 X height cm) – (5.02 X age) – (1.76 x weight kg) -309
  • Women: 6MWD = (2.11 x height cm) – (2.29 x weight kg) – (5.78 x age) + 667m

Considerations:

The 6MWT demonstrated significant differences depending on the length of track used. Asking participants to walk on a 10 meter track where participants were asked to walk back and forth resulted in shorter distances than when asked to walk on a 10 by 50 meter indoor track (Scivoletto et al, 2011). Therefore, it is important to standardize the track for both clinical and research purposes.

The American Thoracic Society guidelines for the Six-Minute Walk Test recommend use of a 30 meter or 100 foot walkway with the length of the corridor marked every 3 meters. Turnaround points are to be marked by a cone (ATS, 2002).

Less affected limb more important than affected limb in explaining variance in walking capacity using 6MWD in chronic incomplete spinal cord injury (Kim et al, 2004) 

Contraindications are unstable angina and MI in the last month since testing (Rasekaba et al, 2004).

Outdoor testing of the 6MWT in participants with stoke can be performed with consideration of the SEM scores. Using a GPS provides similar results as a measuring wheel and may be more convenient while freeing up the hands of the therapist to assist the participant. Testing outdoors over level ground free of street crossings allows for testing in the participants’ own neighborhood after discharge from an impatient facility.

Alzheimer’s Disease: (Tappen et al. 1997) Individuals with moderate to severe Alzheimer’s disease may have impaired balance and require physical assistance to ambulate. Some individuals may also require the use of an assistive device to walk. Examiners may need to use physical and verbal cues during the testing period because patients with Alzheimer’s disease may become distracted or have difficulty understanding directions.

Translated 6MWT:

Spanish:
http://www.aamr.org.ar/secciones/fisiopatologia_lab_pulmonar/prueba6minut.doc

French:
http://www.apa-sante.fr/wiki/tdm6

German:
http://www.sportmedizin-galtuer.at/wp-content/uploads/2013/02/Dr.-Geiger_6-Minuten-Gehtest.pdf

Italian:
http://www.geird.org/protocolli_misura/6-mwt_worksheet_it_vr.pdf

Swedish:
http://www.akademiska.se/Global/Neuro/Sjukgymnastik/Dokument/Behandlingsriktlinjer/NAtionella%20riktlinjer/Riktlinjer%206%20minuters%20g%C3%A5n

Chinese (simplified):
http://www.clinicmed.net/journal/fulltext/volume/1/issue/4/article/410

Japanese:
http://sugp.wakasato.jp/Material/Medicine/cai/text/subject02/no8/html/section17.html

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

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Crapo, R. O., Casaburi, R., et al. (2002). ATS statement: guidelines for the six-minute walk test, AMER THORACIC SOC 1740 BROADWAY, NEW YORK, NY 10019-4374 USA.

Eng, J. J., Dawson, A. S., et al. (2004). "Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption." Arch Phys Med Rehabil 85(1): 113-118. Find it on PubMed

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Redelmeier, D., Bayoumi, A., et al. (1997). "Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients." American journal of respiratory and critical care medicine 155(4): 1278. Find it on PubMed

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Tappen, R. M., Roach, K. E., et al. (1997). "Reliability of physical performance measures in nursing home residents with Alzheimer's disease." J Gerontol A Biol Sci Med Sci 52(1): M52-55. Find it on PubMed

van Hedel, H., Wirz, M., et al. (2005). "Improving walking assessment in subjects with an incomplete spinal cord injury: responsiveness." Spinal Cord 44(6): 352-356.

van Hedel, H. J., Wirz, M., et al. (2005). "Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests." Archives of Physical Medicine and Rehabilitation 86(2): 190-196. Find it on PubMed

van Loo, M. A., Moseley, A. M., et al. (2004). "Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study." Brain Inj 18(10): 1041-1048. Find it on PubMed 

Wevers, L. E., Kwakkel, G., et al. (2011). "Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?" J Rehabil Med 43(11): 1027-1031. Find it on PubMed

Year published

1982 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 6/6/2014 2:20 PM  by Jason Raad