The 6-Minute Walk Test in Chronic Respiratory Failure: Does Observed or Predicted Walk Distance Better Reflect Patient Functional Status?

Güngör, Gökay; Karakurt, Zühal; Adıgüzel, Nalan; Aydin, Rüya; Balcı, Merih Kalamanoğlu; Saltürk, Cüneyt; Sancar, Raziye; Solmaz, Suat; Moçin, Özlem Yazıcıoğlu

doi:10.4187/respcare.02009

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…The lack of association between impaired pulmonary function and performance on the six-minute walk test is unexpected. The six-minute walk test is commonly used as a surrogate of overall fitness, and others have used it to gauge the functional capacity of patients with chronic respiratory and cardiac illnesses, as well as musculoskeletal disorders [27, 28]. This test, however, may not be an optimal tool to study this otherwise young population.…”

Section: Discussionmentioning

confidence: 99%

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Interiano

Kaste

et al. 2017

J Cancer Surviv

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Purpose Longer survival for children with sarcoma has led to the recognition of chronic health conditions related to prior therapy. We sought to study the association of sarcoma therapy with the development of scoliosis. Methods We reviewed patient demographics, treatment exposures, and functional outcomes for patients surviving > 10 years after treatment for sarcoma between 1964–2002 at our institution. The diagnosis of scoliosis was determined by imaging. Functional performance and standardized questionnaires were completed in a long-term follow-up clinic. Results We identified 367 patients, with median age at follow-up of 33.1 years. Scoliosis was identified in 100 (27.2%) patients. Chest radiation [relative risk (RR): 1.88 (95% confidence interval [CI]: 1.21–2.92, p < 0.005,)] and rib resection [RR: 2.64 (CI: 1.79–3.89), p < 0.0001] were associated with an increased incidence of scoliosis; thoracotomy without rib resection was not. Of 21 patients who underwent rib resection, 16 (80.8%) had the apex of scoliosis towards the surgical side. Scoliosis was associated with worse pulmonary function [RR: 1.74 (CI: 1.14–2.66, p < 0.01] and self-reported health outcomes, including functional impairment [RR: 1.60 (CI: 1.07–2.38), p < 0.05] and cancer-related pain [RR: 1.55 (CI: 1.11–2.16), p < 0.01]. Interestingly, pulmonary function was not associated with performance on the six minute walk test in this young population. Conclusions Children with sarcoma are at-risk of developing scoliosis when treatment regimens include chest radiation or rib resection. Identification of these risk factors may allow for early intervention designed to prevent adverse long-term outcomes. Implications for Cancer Survivors Cancer survivors at risk of developing scoliosis may benefit from monitoring of pulmonary status and early physical therapy.

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Section: Discussionmentioning

confidence: 99%

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Interiano

Kaste

et al. 2017

J Cancer Surviv

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“…Reference equations, both actual and as a percent-of-predicted 6MWD, are known to be important for assessing cardiopulmonary function. 16 Ideal 6MWD values were calculated according to a formula, and by using the reference equations provided by Enright and Sherrill. 17 The test results were recorded as ideal [1,140 − (5.61× BMI) − (6.94× age) for males and 1,017 − (6.24× BMI) − (5.83× age) for females], percent-of-predicted (% of ideal 6MWD), and lower limit of normal values (ideal 6MWD − 153 m for males and ideal 6MWD − 139 m for females), according to previous methods.…”

Section: Methodsmentioning

confidence: 99%

Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

Saltürk

Karakurt

Takır

et al. 2015

COPD

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IntroductionThe objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies.MethodsThis retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group).ResultsA total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient −24.48; 95% CI −48.74 to −0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI −3.79 to 57.66, P=0.085).ConclusionThe 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses.

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“…The use of 6MWD %pred versus 6MWD in meters in idiopathic pulmonary fibrosis [40,41], chronic lung diseases [42] and congestive heart failure [43] better reflects patients' clinical status. In PAH, despite the long-standing use of 6MWD, it is largely unknown whether the %pred is a better marker of disease severity than 6MWD in meters; Lee et al [13 ]showed that %pred was not better for predicting mortality.…”

Section: Discussionmentioning

confidence: 99%

Early Decline in Six-Minute Walk Distance from the Time of Diagnosis Predicts Clinical Worsening in Pulmonary Arterial Hypertension

Huang

Mehta²,

Mura

2015

Respiration

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Background: The six-minute walk distance (6MWD) is commonly used to assess pulmonary arterial hypertension (PAH). However, the role of 6MWD in predicting outcomes in PAH is controversial. Clinical worsening is being increasingly considered as a clinically meaningful end point in PAH. Objectives: We aimed to investigate whether early longitudinal changes in 6MWD (Δ6MWD) in meters and percent predicted (%pred) from the time of diagnosis predict clinical worsening of PAH. Methods: One hundred patients with group I PAH were retrospectively assessed. 6MWD was calculated using American (%pred US) or Canadian (%pred CAN) reference equations. Δ6MWD at 6 months were recorded. Clinical worsening was defined as either: development of right heart failure, hospital admission for PAH, referral for lung transplantation or initiation of prostanoids after oral therapy failed. Optimal 6-month differences in 6MWD to detect worsening were defined with receiver operating characteristics (ROC) analysis. Results: Progressors, i.e. patients with clinical worsening, and nonprogressors showed significant differences in Δ6MWD. The most clinically significant declines in 6MWD at 6 months were ≥35 m, ≥8%pred US and ≥6%pred CAN. ROC and Cox proportional hazard analyses showed equivalent results for 6MWD %pred and meters. Six-month declines in 6MWD predicted worsening with a high specificity (94%) but a low sensitivity (33%). Conclusions: Early declines in 6MWD (within the first 6 months) predict future clinical worsening of PAH with high specificity. Δ6MWD may still be part of a comprehensive assessment of a patient's clinical status. However, given the poor sensitivity, a decline in 6MWD should be used with other clinical tools to make an appropriate assessment of the progression of PAH.

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The 6-Minute Walk Test in Chronic Respiratory Failure: Does Observed or Predicted Walk Distance Better Reflect Patient Functional Status?

Cited by 8 publications

References 32 publications

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

Early Decline in Six-Minute Walk Distance from the Time of Diagnosis Predicts Clinical Worsening in Pulmonary Arterial Hypertension

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