Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis
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REVIEW ARTICLE
Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis Alice Macchiavelli 1 & Antonella Giffone 2 & Francesco Ferrarello 3 & Matteo Paci 4 Received: 21 December 2019 / Accepted: 12 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Purpose The six-minute walking test (6MWT) is a simple and widely used measure of functional capacity. The aim of this systematic review is to summarize findings on reliability of 6MWT in subjects who have had a stroke. Methods Two independent investigators conducted an extensive search in multidisciplinary electronic databases from inception to August 2019, and selected complete original studies on the reliability of the 6MWT used to assess individuals with stroke. Two reviewers independently extracted data and evaluated methodological quality. Outcome for meta-analysis was reliability, measured by intraclass correlation coefficient (ICC). In addition, standard error of measurement (SEM) and minimal detectable change (MDC) were recorded. Results Of the 241 potentially relevant articles screened, 6 met inclusion criteria and 5 of them were included in meta-analysis. Combined correlation coefficient of .98 (confidence interval .98–.99) was found for test-retest reliability. Only one study investigated inter-rater and intra-rater reliability. SEM and MDC values were rarely reported. Conclusions The 6MWT has high test-retest reliability, when used to assess individuals with stroke. Other types of reliability and SEM and MDC need further investigations in populations with a stroke. Keywords Reliability . Outcomes . Stroke . Walk test . Outcome assessment
Introduction Compromised walking ability and functional capacity are limitations significantly associated with poorer community integration following stroke [1]. The six-minute walk test (6MWT), firstly described in 1985 [2], is a simple, widely used measure of functional capacity [3–6]. In 2002, the American Thoracic Society (ATS) published guidelines for the 6MWT [7] in order to standardize the protocol to encourage comparisons among different studies and populations. The ATS guidelines include test indications and contraindications, safety measures, and a step-by-step protocol and * Matteo Paci [email protected] 1
School of Physiotherapy, University of Florence, Florence, Italy
2
IRCCS Fondazione Don Gnocchi, Florence, Italy
3
Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Prato, Italy
4
Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Florence, Italy
provide assistance with clinical interpretation. Key components of the protocol include the test location, walkway length, measurements, and instructions. The protocol prescribes to perform the test on a flat, indoor walkway, 30 m long; additional space is required to allow 180∘ turns at either end of the walkway. The guidelines underline that shorter walkways require more directional changes, thus reducing the distance achieved [7]. A number of systematic re
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