Assessment Overview

Purpose: The 6 Minute Walk Test (6MWT) is a measure of walking distance. The patient attempts to walk as far as he/she can in six minutes. The patient is allowed to stop and rest, but they must remain standing. This test is not feasible or appropriate for patients who cannot walk. A patient may use an assistive device during this test. This test should be performed in a 12 meter hallway

Equipment: Stopwatch, 12 meter hallway with marked turn-around points

ICF Category: Activity

Assessment Handout

Assessment Psychometrics

Stroke

The 6MWT is highly recommended for use in those with acute, subacute, or chronic strokes and is highly recommended for use in acute care, inpatient rehabilitation, skilled nursing facilities, outpatient rehabilitation, and home health. This measure should be taught to students and is appropriate for use in research. Standardization of the test is essential for accurate measures as previous studies indicate patients completing the test on a 10m track walked significantly shorter distances compared to those on a 10x50m indoor track.

• Concurrent Validity: Excellent 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=-.80). Excellent between first (r=0.98) and second (r=0.99) 6MWT using GPS and measuring wheel

• Construct Validity: Excellent correlation with 2MWT (r=0.997) and 12MWT (r=0.99), Excellent relationship with BBS (r=0.69) Adequate relationship with quadriceps strength (r = 0.57), Adequate correlation with Reintegration to Normal Living Index (RNL) (r=0.37)

• Criterion Validity: Excellent correlation with Vo2 max (r=0.66), Excellent correlation between Five Meter Walk Test (r=0.79), Adequate correlation with Vo2peak (r=0.56 and test duration (r=0.60)

• Cutoff Score: None reported

• Floor/Ceiling Effects: No floor or ceiling effects reported

• Interrater Reliability: Adequate Intra-rater reliability (ICC=0.74)

• Intrarater Reliability: Adequate Inter-rater reliability (ICC=0.78)

• MCID: 34.4m

• Mean Data: GPS 1st measurement (408m), GPS 2nd measurement (417m), Measuring wheel 1st measurement (413m), Measuring wheel 2nd measurement (422m)

• MDC: Subacute: 60.98m, Chronic: 36.6m or 13% change

• Responsiveness: Over 3.9 week inpatient rehabilitation stay SRM = 1.52

• SEM: 11.9m (measuring wheel) 18.1 m (GPS)

• Test-retest: Excellent (ICC=0.99)

Multiple Sclerosis

Neuro PT EDGE stated different recommendations for this test depending on practice setting. It is highly recommended (4/4) for inpatient rehab and the outpatient setting. It is recommended (¾) for acute care and skilled nursing. The 6MWT is highly recommended (4/4) for individuals with an EDSS of 0.0-3.5 and 4.0-5.5. It is recommended (¾) for individuals with an EDSS of 6.0-7.5. Students should learn to administer this tool with the MS population, and it has been validated for use in research. The psychometric properties available for the use of the 6MWT with the MS population are presented in the list below.

• Concurrent Validity: Functional stair test (rho=-0.85, p=0.0) ; Sit to stand test (rho=0-0.82, p=0.0) ; EDSS Score (rho=-0.82, p<0.01)

• Interrater Reliability: ICC=0.94 on 40 pts with MS ; ICC=0.93 in 19 pts with MS

• Intrarater Reliability: ICC=0.91; 40 pts MS

• MCID: 55.06m with EDSS as the anchor ; 55.35m with pt’s perception of change as the anchor

• MDC: 92.16 m in 120 pts with MS

• Test-retest Reliability: ICC=0.96

One of the strengths of the 6MWT is that it is recognized as a core outcome measure by the ANPT. This means that it should be used routinely in all settings with adults with neurological conditions. One weakness in regards to the use of this test with people with MS is that there have only been a couple of studies using the MS population in particular. There is not enough data to report a norm for this population on the 6MWT. However, in a recent meta-analysis, the mean of people with MS in the studies was found to be 452.1 m (SD=103.2m). In the meta-analysis, the healthy controls walk significantly farther than those with MS: mean difference of -173.6m for those with mild disability, and -185.2m for those with moderate-to-severe disability. This meta-analysis included 2683 individuals with MS and 521 healthy individuals.

Parkinson's Disease

The 6MWT is highly recommended for use in patients in Hoehn and Yahr stages I-IV of PD, but not recommended for use with patients diagnosed in Hoehn and Yahr stage V of PD. The 6MWT has limited studies on use in acute care and skilled nursing facilities but is recommended for use in inpatient rehabilitation, and outpatient rehabilitation. This measure should be taught to students and is appropriate for use in research. Standardization of the test is essential for accurate measures as previous studies indicate patients completing the test on a 10m track walked significantly shorter distances compared to those on a 10x50m indoor track.

• MDC: 82 meters

• Test-retest: Excellent (ICC=0.95-0.96)

Spinal Cord Injury

According to Neuro PT EDGE recommendations, the 6MWT is highly recommended (4/4) for acute, subacute, and chronic SCI patients. The 6MWT is also highly recommended for motor incomplete SCI (AIS C and D) and reasonable to use (2/4) with motor complete SCI (AIS A and B) patients. Students should learn to administer this tool, and this tool is appropriate for research. The psychometrics for the 6MWT are presented below:

• Content Validity: Useful but requires validation

• Criterion Validity: Excellent with the 10 Meter Walk Test, r=-0.95 ; Adequate in reference to the Timed Up and Go, r= -0.88 ; Poor in reference to the Walking Index for WISCI II, r= 0.60

• Interrater Reliability: ICC=0.99, r=0.97

• Intrarater Reliability: ICC=0.99

• MCID: 0.10 m/s, with a cohort of AIS C and D individuals

• Mean: Gym - 382.39 meters; Community - 401.44 meters

• MDC: 45.8 meters

• Responsiveness: Significant difference between 1 and 3 months (mean of 314 increased to 373 meters and between 3 and 6 months (mean of 473 to 502 meters). ; No difference between 6 and 12 months (mean of 502 to 495 meters).

• SEM: 16.5 meters

Traumatic Brain Injury

The 6MWT is highly recommended for use in patients after brain injury who are completely independent. It is also recommended for those who are mildly dependent. There is not yet evidence to recommend use for those that are moderately dependent and it is not recommended for those who are severely dependent. The 6MWT has limited studies on use in acute care and skilled nursing facilities but is recommended for use in inpatient rehabilitation, and outpatient rehabilitation. The 6MWT is not recommended for use in home health. This measure should be taught to students and is appropriate for use in research. Standardization of the test is essential for accurate measures as previous studies indicate patients completing the test on a 10m track walked significantly shorter distances compared to those on a 10x50m indoor track.

• Test-retest: Excellent (ICC=0.94)