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Rehab Measures: 2 Minute Walk Test

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2 Minute Walk Test Instructions 

Title of Assessment

2 Minute Walk Test 

Acronym

2MWT

Instrument Reviewer(s)

Initially reviewed by Rachel Tappan, PT, NCS in 2010; Updated with references from the geriatric population by Ernesto Garcia, SPT and Matthew Walthers, SPT in 2011; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references from the geriatric population by Ernesto Garcia, SPT and Matthew Walthers, SPT in 2012; Updated with references for the PD population in 2013.

Summary Date

2/28/2013 

Purpose

Measurement of endurance by assessing walking distance over 2 minutes

Description

  • Walk or cover as far a distance as possible over 2 minutes
  • Assistive devices can be used but should be kept consistent from test to test
  • Individual should be able to ambulate without physical assistance
  • NIH toolbox adapted the structions from the American Thoracic Society's 6 minute walk test. Normative data establish with n = 4800 ages 5 - 85. NIH study utilized a 50 ft course. One trial was performed.
  • Parkinson's disease: The 2 MWT requires up to 2 practice sessions to reduce a practice effect (Light et al, 1997), with Light noting that the walking distance increased significantly over 3 trials in a population of individuals with Parkinson's disesase.

Area of Assessment

Aerobic Capacity; Functional Mobility; Gait 

Body Part

Not Applicable 

ICF Domain

Activity 

Domain

Motor 

Assessment Type

Observer 

Length of Test

05 Minutes or Less 

Time to Administer

<2 minutes

Number of Items

Not applicable 

Equipment Required

Stop watch

 

Training Required

None

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Chronic Obstructive Pulmonary Disease; Lower Limb Amputation; Multiple Sclerosis; Spinal Cord Injury; Stroke; Traumatic Brain Injury 

Populations Tested

  • Cardiac surgery
  • COPD
  • Lower Extremity Amputation
  • Multiple Sclerosis
  • Neurologic impairment (stroke, head injury, and tumor)
  • Older adults/Geriatric
  • Spinal Cord Injury

Standard Error of Measurement (SEM)

Lower Extremity Amputation:

(Resnik & Borgia, 2011, n = 44 [unilateral LE amputations, > 2 years post, current prosthesis users], mean age = 66 (13) years, assessed twice in a week, US sample, LE Amputation)

  • SEM = 14.9 meters or 48.5 feet (95% confidence)

Neurologic:

(Rossier & Wade, 2001, n = 46 (21 chronic stroke, 25 other), mean age = 47 (13) years, assessed twice at a 7 day interval, UK sample, Neurologic)

  • SEM = 12 meters or 40 feet (95% confidence)

Older Adults:

(Connelly & Thomas, 2009, n = 16, residents of long term care [LTC], mean age 87, Canadian sample, Older Adults)

  • SEM = 6.3 meters or 20.7 feet (95% confidence)

Stroke:

(Hiengkaew et al, 2012, n = 61, mean age = 63.5, assessed twice at a 6 day interval, Thailand sample, Chronic Stroke)

  • SEM = 4.83 meters (95% confidence)

Multiple Sclerosis:

(Gijbels et al, 2010; n = 50 (29 mild, 21 moderate MS); mean age = 49 (10) years; assessed twice at a 7 day interval, Belgium sample, Multiple Sclerosis)

  • SEM = 6.93 meters (95% confidence)

(Gijbels et al, 2011, n = 40, ambulatory pwMS, mean age=48, Belgium sample, Multiple Sclerosis)

  • SEM (calculated) = 7.59 meters (95% confidence)

Minimal Detectable Change (MDC)

Lower Extremity Amputation:

(Resnik & Borgia, 2011, LE Amputation)

  • MDC (calculated) = 34.3 meters or 112.5 feet (90% confidence)

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • MDC = 19.21 meters (95% confidence)

Neurologic:

(Rossier & Wade, 2001, Neurologic)

  • MDC (calculated) = 16.4 meters or 53.8 feet (95% confidence)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • MDC (calculated) = 12.2 meters or 40 feet (90% confidence) 

Stroke:

(Hiengkaew et al, 2012, Chronic Stroke)

  • MDC = 13.4 meters (95% confidence)

(Gijbels et al, 2011)

  • MDC (calculated) = 21.04 meters (95% confidence)

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Mean (SD) 2MWT (m) score = 144 (49), range = 92-630)
    • Mean (SD) 2MWT (m) score for mild MS = 173 (31), range = 108-220
    • Mean (SD) 2MWT (m) score for moderate MS = 104 (41), range = 40-172)

(Gijbels et al, 2012, n = 189, mean age = 47 (11) years, European and US sample, cross-sectional multicentre design, Multiple Sclerosis)

  • Mean (SD) gait velocities (m/s) – static start, fastest speed; 1.14 (0.42), range = 0.31 to 2.00
    • Mild MS (EDSS < 4.0, n = 99) Mean (SD) gait velocities (m/s); 1.39 (0.31), range = 0.58 to 2.00
    • Moderate MS (EDSS 4.5-6.5, n = 79) Mean (SD) gait velocities (m/s); 0.81 (0.30), range=0.31 to 1.67

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Mean (SD) 2MWT for long term care group (LTC); 77.5 (25.6) meters
  • Mean (SD) 2MWT for retirement dwelling older adults; 150.4 (23.1) meters

SCI:

(Lemay & Nadeau, 2010; n = 32; mean age = 47.9 (12.8); mean time post lesion 77.2 (44.3) days, SCI)

  • Mean (SD) 2MWT (m) score; 109.3 (48.6), range = 11 to 214
    • Mean (SD) 2MWT for Paraplegia; 101.3 (50.0), range = 11 to 212
    • Mean (SD) 2MWT for Tetraplegia; 115.9 (48.0), range = 43 to 214

Stroke:

(Gijbels et al, 2011, Chronic Stroke)

  • Mean (SD) 2MWT; 149 (48), range = 30 to 223 meters

Test-retest Reliability

COPD:

(Leung et al, 2006, n = 45, mean age = 71.8 (8.3) years, Chinese sample, COPD)

  • Excellent test-retest reliability (r = 0.9994)

Lower Extremity Amputation:

(Resnik & Borgia, 2011, LE Amputation)

  • Excellent test-retest reliability (ICC = 0.83)

Neurologic Impairment:

(Rossier & Wade, 2001, Neurologic Impairment)

  • Excellent test-retest reliability (ICC = 0.97)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excellent test-retest reliability (ICC = 0.95)

Stroke:

 (Hiengkaew et al, 2012, Chronic Stroke)

  • Excellent test-retest reliability (ICC = 0.98)

Interrater/Intrarater Reliability

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Poor intrarater reliability
  • Poor interrater reliability

Stroke:

(Miller et al, 2002, n = 39, [32 subjects with incidence of cerebrovascular accident], mean age 69.6 (13) years, Canadian sample, Acute Stroke)

  • Excellent interrater reliability (ICC = 0.98 & 0.92 for maximal and comfortable walk tests respectively)

(Kosak and Smith, 2005, n = 18; mean age = 77 (11) years; mean time post stroke = 28 (34) days, Acute Stroke)

  • Excellent inter-rater reliability (ICC = 0.85, p < 0.0007)
  • Excellent intra-rater reliability (ICC = 0.85, p < 0.0003)

 (Hiengkaew et al, 2012, Chronic Stroke)

  • Excellent interrater reliability (ICC = 0.85)
  • Excellent intrarater reliability (ICC = 0.85)

Transtibial Amputation:

(Brooks et al, 2002, Transtibial Amputation)

  • Excellent interrater reliability (ICC = 0.98-0.99)
  • Excellent intrarater reliability (ICC = 0.90-0.96)

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Adequate concurrent validity between the mild and moderate MS 2-minute walk tests (r = 0.64)

(Gijbels et al, 2011, Multiple Sclerosis)

  • Adequate concurrent validity between the 2MWT and EDSS (r = -0.61)
  • Good concurrent validity between the 2MWT and MSWS-12 (r = -0.72)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excelllent concurrent validity between 2MWT and Berg Balance Scale (r = 0.88)

(Brooks et al, 2004, n = 122, mean age = 63 (9) years, [patients undergoing coronary artery bypass grafting], Canadian sample, Older Adults)

  • Adequate concurrent validity between the 2MWT and the SF-36 (r = 0.44, 0.48; pre-operatively and at follow-up respectively)

Stroke:

(Miller et al, 2002, Acute Stroke)

  • Excellent concurrent validity between maximal and comfortable two minute walk tests (r = 0.93)
  • Adequate concurrent validity between the comfortable two minute walk test and the Functional Independence Measure (FIM) (r = 0.58)

Construct Validity (Convergent/Discriminant)

Cardiac Surgery (CABG):

(Brooks et al, 2004, n = 122 (but 20 lost during follow-up); mean age=63.4 (8.6); 49% NYHA class I or II, 28% NYHA class III or IV, CABG)

  • Adequate correlation (r = 0.44-0.48) between 2MWT and SF36 physical functioning subscale
  • Poor correlation (r = 0.12 (-0.03) between 2MWT and SR36 social functioning subscale Inpatient

COPD:

(Leung et al, 2006, COPD)

  • Excellent correlation with the 6MWT (r = 0.937)
  • Adequate correlations were found with the VO2max (r = 0.454) and the VO2max/kg (r = 0.555)

Geriatrics:

(Brooks et al, 2006, Inpatient Geriatrics)

  • Adequate correlation between 2MWT and admission FIM score (r = 0.59)

(Brooks et al, 2006, n = 52; mean age = 79.9 (7.7); length of stay in rehab = 1.4 (0.6), Geriatrics)

  • Adequate correlation (r = 0.47-0.59) between 2MWT and FIM score
  • Excellent correlation (r = 0.81-(-)0.68) between 2MWT and TUG
  • Adequate correlation (r = 0.35-0.42) between 2MWT and Modified Barthel Index
  • Adequate correlation (r = 0.41-0.51) between 2MWT and FRT

Lower Extremity Amputation:

(Salavati et al, 2010, n = 106, mean age = 44.9 (6.6) years, [lower limb amputees], Persian sample, LE Amputation)

  • Excellent correlation with the Locomotors Capabilities Index (LCI-5) (r = 0.71, P < 0.01)

Multiple Sclerosis:

(Gijbels et al, 2011, Multiple Sclerosis)

  • Walking distances across 1 minute intervals of 2MWT and 2’_6MWT did not differ significantly (p = 0.82)

(Gijbels et al, 2012, Multiple Sclerosis)

  • Excellent correlation with 6MWT (r = 0.97, p < 0.01)
    • Excellent correlation with 6MWT in patients with mild MS (r = 0.94, p < 0.01)
    • Excellent correlation with 6MWT in patients with moderate MS (r = 0.96, p < 0.01)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excellent correlation with the 6MWT (r = 0.93)
  • Excellent correlation with the Timed Up and Go test (r = -0.87)

Stroke:

(Kosak & Smith 2005, inpatient rehab 28-34 days post stroke, Acute Stroke)

  • Excellent correlation with the 6 Minute Walk Test (6MWT) (r = 0.997)

SCI:

(Lemay & Nadeau, 2010, SCI)

Convergent Validity Evidence:

Measure

2MWT

10MWT

TUG

BBS

0.781**

0.792**

-0.815**

2MWT

0.932 a**

-0.623 a**

10MWT

-0.646 a**

a = Pearson’s product moment correlation; other coefficients are Spearman’s r

**Significant at p < 0.01

 

Content Validity

Neurologic Impairment:

(Rossier & Wade, 2001)

  • Subjects using an assistive device (p < 0.0005) or with LE sensory impairments (p = 0.02) scored lower on the 2MWT

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Cardiac Surgery (CABG):

(Brooks et al, 2004, CABG)

  • No significant difference in 2MWT between individuals who developed cardiac or pulmonary complications postoperatively and those who did not (p ≥ 0.02)

COPD:

(Leung et al, 2006, COPD)

  • Significant improvements on 2MWT after pulmonary rehab, an increase of 17.2 (13.8) meters

(Leung et al, 2006, COPD)

  • Large effect size (0.61) found after a 5 week pulmonary rehab program (increase of 17.2 (13.8) m on the 2MWT)
  • Standardized response mean score 1.25

Geriatrics:

(Brooks et al, 2006, Inpatient Geriatrics)

  • Standardized response mean score 0.7

Lower Extremity Amputation:

(Brooks et al, 2001, LE Amputation)

  • Responsive to change with rehabilitation for lower extremity amputation

Multiple Sclerosis:

(Gijbels et al, 2012, Multiple Sclerosis)

  • 2MWT is justified as practical replacement for 6MWT in pwMS as demonstrated by high univariate regression coefficient = 0.97 and low mean relative estimation error = 5%. P < 0.01

Older Adults:

(Brooks et al, 2007, n = 52, mean age = 80(8) years, Canadian sample, Older Adults)

  • The 2MWT was more tolerable than the 6MWT in inpatient geriatric rehab population. All patients were able to complete the 2MWT whereas 1 patient completed the 6MWT out of the 8 patients who tried.

 

Stroke:

(Kosack and Smith, 2005, Acute Stroke)

  • Standardized response mean score 1.34 (F = 24.24, p < 0.001)

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

NR

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

UR

UR

UR

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)

MS EDGE

Yes

Yes

No

TBI EDGE

No

Yes

Yes

Considerations

Should only be used on individuals who are able to ambulate without physical assistance
 
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Bibliography

Brooks, D., Davis, A. M., et al. (2006). "Validity of 3 physical performance measures in inpatient geriatric rehabilitation." Arch Phys Med Rehabil 87(1): 105-110. Find it on PubMed

Brooks, D., Davis, A. M., et al. (2007). "The feasibility of six-minute and two-minute walk tests in in-patient geriatric rehabilitation." Can J Aging 26(2): 159-162. Find it on PubMed

Brooks, D., Hunter, J. P., et al. (2002). "Reliability of the two-minute walk test in individuals with transtibial amputation." Archives of Physical Medicine and Rehabilitation 83(11): 1562-1565. Find it on PubMed

Brooks, D., Parsons, J., et al. (2001). "The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation." Archives of Physical Medicine and Rehabilitation 82(10): 1478-1483. Find it on PubMed

Brooks, D., Parsons, J., et al. (2004). "The two-minute walk test as a measure of functional capacity in cardiac surgery patients." Archives of Physical Medicine and Rehabilitation 85(9): 1525-1530. Find it on PubMed

Canning, C. G., Ada, L., et al. (2006). "Walking capacity in mild to moderate Parkinson's disease." Archives of Physical Medicine and Rehabilitation 87(3): 371-375. Find it on PubMed

Connelly, D. M., Thomas, B. K., et al. (2009). "Clinical utility of the 2-minute walk test for older adults living in long-term care." Physiotherapy Canada 61(2): 78-87. Find it on PubMed

Ellis, T., Katz, D. I., et al. (2008). "Effectiveness of an inpatient multidisciplinary rehabilitation program for people with Parkinson disease." Phys Ther 88(7): 812-819. Find it on PubMed

Gijbels, D., Alders, G., et al. (2010). "Predicting habitual walking performance in multiple sclerosis: relevance of capacity and self-report measures." Mult Scler 16(5): 618-626. Find it on PubMed 

Gijbels, D., Dalgas, U., et al. (2012). "Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set." Mult Scler 18(3): 364-371. Find it on PubMed

Gijbels, D., Eijnde, B. O., et al. (2011). "Comparison of the 2- and 6-minute walk test in multiple sclerosis." Mult Scler 17(10): 1269-1272. Find it on PubMed

Hiengkaew, V., Jitaree, K., et al. (2012). "Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone." Arch Phys Med Rehabil 93(7): 1201-1208. Find it on PubMed

Kosak, M. and Smith, T. (2005). "Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke." J Rehabil Res Dev 42(1): 103-107. Find it on PubMed

Lemay, J. F. and Nadeau, S. (2010). "Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale." Spinal Cord 48(3): 245-250. Find it on PubMed

Leung, A. S., Chan, K. K., et al. (2006). "Reliability, validity, and responsiveness of a 2-min walk test to assess exercise capacity of COPD patients." Chest 130(1): 119-125. Find it on PubMed

Light, K. E., Bebrman, A. L., et al. (1997). "The 2-minute walk test: a tool for evaluating walking endurance in clients with Parkinson's disease." Journal of Neurologic Physical Therapy 21(4): 136.

Miller, P. A., Moreland, J., et al. (2002). "Measurement properties of a standardized version of the two-minute walk test for individuals with neurological dysfunction." Physiotherapy Canada 54(4): 241-248.

Resnik, L. and Borgia, M. (2011). "Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error." Physical Therapy 91(4): 555-565. Find it on PubMed

Reuben, D. B., Magasi, S., et al. (2013). "Motor assessment using the NIH Toolbox." Neurology 80(11 Supplement 3): S65-S75.

Rossier, P. and Wade, D. T. (2001). "Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment." Arch Phys Med Rehabil 82(1): 9-13. Find it on PubMed

Salavati, M., Mazaheri, M., et al. (2011). "The Persian version of locomotor capabilities index: translation, reliability and validity in individuals with lower limb amputation." Quality of Life Research 20(1): 1-7. Find it on PubMed

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease." Phys Ther 91(9): 1339-1354. Find it on PubMed

Stewart, D. A., Burns, J. M. A., et al. (1990). "The two-minute walking test: a sensitive index of mobility in the rehabilitation of elderly patients." Clinical Rehabilitation 4(4): 273-276.

White, D. K., Wagenaar, R. C., et al. (2009). "Changes in walking activity and endurance following rehabilitation for people with Parkinson disease." Arch Phys Med Rehabil 90(1): 43-50. 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 1/27/2014 3:57 PM  by Jason Raad