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Rehab Measures - 6 Minute Walk Test

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Rehab Measures: 6 Minute Walk Test

Link to instrument

6 Minute Walk Test Instructions

Title of Assessment

6 Minute Walk Test

Acronym

6MWT

Instrument Reviewer(s)

Created 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

Summary Date

4/20/2012

Purpose

Assesses distance walked over 6 minutes

Description

Performed at the fastest speed possible


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

Fibromyalgia; Geriatrics; Multiple Sclerosis; Parkinsons Disease; Spinal Cord


Injury; Stroke

Populations Tested

Pulmonary disease
Heart failure
Stroke
Spinal cord injury
Geriatrics
Fibromyalgia
Multiple sclerosis

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Parkinsons Disease

Standard Error of
Measurement (SEM)

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)
SEM for strenth training trial = 21 meters
SEM for interventional trial = 22 meters
Chronic Stroke: (Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years;
mean time since stroke onset 15 (5) months)
SEM = 18.6 meters
Acute SCI: (Lam et al, 2008; SCI measures meta analysis; Incomplete SCI;
C2-L1; < 12 months post injury)
SEM = 16.5 meters

Minimal Detectable Change


(MDC)

Chronic Stroke: (Flansbjer et al, 2005)


MDC = 36.6 meters
SCI: (Lam et al, 2008)
MDC = 45.8 meters
COPD: (Redelmeier et al, 1997; n = 112 patients with COPD; mean age = 67
years; mean FEV1 = 975 ml)
MDC = 54 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)
MDC = 82 meters

Minimally Clinically
Important Difference
(MCID)

Geriatrics and Stroke: (Perera et al, 2006)

Cut-Off Scores

Not Established

Normative Data

Community-dwelling Elderly: (Steffen et al, 2002; n = 96 communitydwelling elderly people with independent function who are nonsmokers with
no history of dizziness; mean age = 73 (8) years)

MCID = 50 meters

Mean Distance in Meters by Age & Gender


Age

Male

Female

60-69yrs

572m

538m

70-79yrs

527m

471m

80-89yrs

417m

392m

Healthy Caucasian Children: (Geiger et al, 2007; n = 528 healthy


caucasian children between 3 and 18 years old (280 males, 248 females)

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Modified 6MWT distance in children


Age

Male

Female

3-5yrs

536.5 (95.6) 501.9 (90.2)

6-8yrs

577.8 (56.1) 573.2 (69.2)

9-11yrs

672.8 (61.6) 661.9 (56.7)

12-15yrs 697.8 (74.7) 663.0 (50.8)


16-18yrs 725.8 (61.2) 664.3 (49.5)
Acute SCI: (Barbeau et al, 2007; n = 107 patients with ASIA C and D grade
SCI; n = 38 patients with ASIA B grade SCI; all subjects had lesions between
C-5 and L-3, tested at 3, 6 and 12 months post-injury)
Comparison of Walking Speed Within Subjects With Upper Motor
Neuron Lesions During the Spinal Cord Injury Locomotor Trial (SCILT):
Months after
entry to trial

Walking Speed (m/s)


over 6 minutes

Walking Speed
(m/s) over 15.2m

p
value

66

0.64 (0.06)

0.72 (0.05)

.14

69

0.79 (0.05)

0.92 (0.06)

.29

12

70

0.88 (0.06)

1.08 (0.06)

.001

*Gait speed collected over 6 minutes and 10 meters were only significantly
correlated after 12 months
Chronic SCI: (Olmos et al, 2008; n = 18 participants with ASIA D grade SCI
more than 6 months from injury; tested three times each with a 60 minute
interval between test runs, in a Physical Therapy gym versus community; age
range = 16-75 years)
Six-Minute Walking Test (m)
6 MWT gym 6 MWT community
Mean

382.39

401.44

Median

371.75

367.80

SD

120.988

130.276

Min

151

151

Max

560

584

Parkinson's Disease: (Falvo and Earhart, 2009; n = 80 individuals with mild


to moderate PD; mean age = 66.3 (9.8) years)
Mean distance walked = 394.1 (98.4) meters
Test-retest Reliability

Chronic 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)
Excellent Test-retest reliability for distance covered (meters) (ICC=
0.96)
Excellent Test-retest reliability for VO2 (ICC= 0.99)
Chronic Stroke: (Flansbjer et al, 2005)
Excellent Test-retest reliability (ICC = 0.99)
Acute Stroke: (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)

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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)
Interrater/Intrarater
Reliability

Acute Stroke: (Kosak & Smith, 2005; n = 18 patients enrolled in inpatient


rehabilitation after stroke ; mean age = 77 (11) years; mean time since stroke
onset = 28 (34) days; mean FIM score at time of admission to inpatient
rehabilitation = 68 (17))
Adequate Intrarater reliability (ICC = 0.74)
Excellent Interrater reliability (ICC = 0.78)
SCI: (van Hedel et al, 2005; n = 22 SCI patients assessed at within the first
month injury reassessed at 3, 6, and 12 months; mean age = 45.5 (16.7)
years; Walking Index for Spinal Cord Injury (WISCI II) score > 1; quoted from
Lam et al; 2008)
Excellent interrater reliability (r = 0.97)
Excellent intrarater reliability (r = 0.981)
Chronic SCI: (Scivoletto et al, 2011; n = 37 subjects subacute or chronic
incomplete SCI; median age = 58.5 (1977) years; median time from onset =
24 (range 6109) months; ASIA D = 35, C = 2; median WISCI = 16)
Excellent interrater reliability (ICC = 0.99)
Excellent intrarater reliability (ICC = 0.99)

Internal Consistency

Not Established

Criterion Validity
(Predictive/Concurrent)

Chronic Stroke: (Patterson et al, 2007, n = 74, mean age = 64 (10) years;
time since stroke onset 48 (59) months; dichotomized based on median
speed)
Results indicate that faster walkers had significantly higher
(p<.02) values on:
Berg Balance Scale
VO2 peak measurements
Distance during the 6MWT
Paretic leg strength
Nonparetic leg strength
Spinal Cord Injury: (van Hedel et al, 2005)
Excellent concurrent validity with:
Timed Up and Go (r = -0.88)
10 Meter Walk Test (r = -0.95)
WISCI II (r = 0.60)
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)
Excellent concurrent validity with:
Chair stands (r = 0.67)
Gait speed (r = -0.73)
Adequate concurrent validity with:
Standing balance (r = 0.52)
SCI: (Lam et al, 2008)

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Excellent concurrent validity with:


10 Meter Walk Test (r = -0.95)
TUG (r = -0.88)
Walking Index for SCI (r = 0.60)
Construct Validity
(Convergent/Discriminant)

Spinal Cord Injury: (Musselman and Brunton, 2011; n = 32 individuals with


incomplete SCI; sex = 24 males, 8 females; mean age = 47.6 (14.2) years)
Adequate correlation between the 6MWT and SCI-FAP (r = -0.59)

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)
Expert Evaluations:
Measure

Valid or
Useful but
Useful requires validation

10 Meter
Walk Test

32 (60%)

6 Minute
Walk Test
FIM-L

Not useful or valid


for RESEARCH

Total
Votes

20 (38%)

1 (2%)

53

19 (37%)

30 (58%)

3 (6%)

52

3 (6%)

18 (36%)

29 (58%)

50

Votes (%)
Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

SCI: (van Hedel et al, 2005)


For patients with incomplete SCI, the 6MWT was able to detect walking
capacity improvements in patients with less ambulatory impairment
during the acute stages of recovery and 6 months post injury. Similar
findings were demonstrated with the WISCI II or Lower-Extremity Motor
Scores (LEMS).

Professional Association
Recommendations
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.

Bibliography

Casanova, C., Cote, C. G., et al. (2007). "The 6-min walking distance: longterm follow up in patients with COPD." Eur Respir J 29(3): 535-540. Find it on
PubMed
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
Flansbjer, U. B., Holmback, A. M., et al. (2005). "Reliability of gait
performance tests in men and women with hemiparesis after stroke." J
Rehabil Med 37(2): 75-82. Find it on PubMed
Fulk, G. D. and Echternach, J. L. (2008). "Test-retest reliability and minimal
detectable change of gait speed in individuals undergoing rehabilitation after
stroke." J Neurol Phys Ther 32(1): 8-13. Find it on PubMed
Geiger, R., Strasak, A., et al. (2007). "Six-minute walk test in children and

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Rehab Measures - 6 Minute Walk Test

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Geiger, R., Strasak, A., et al. (2007). "Six-minute walk test in children and
adolescents." The Journal of pediatrics 150(4): 395-399. Find it on PubMed
Harada, N., Chiu, V., et al. (1999). "Mobility-related function in older adults:
assessment with a 6-minute walk test." Archives of physical medicine and
rehabilitation 80(7): 837-841. Find it on PubMed
Lam, T., Noonan, V., et al. (2007). "A systematic review of functional
ambulation outcome measures in spinal cord injury." Spinal Cord 46(4): 246254.
Olmos, L. E., Freixes, O., et al. (2008). "Comparison of gait performance on
different environmental settings for patients with chronic spinal cord injury."
Spinal Cord 46(5): 331-334. Find it on PubMed
Patterson, S., Forrester, L., et al. (2007). "Determinants of walking function
after stroke: differences by deficit severity." Archives of physical medicine and
rehabilitation 88(1): 115-119. Find it on PubMed
Perera, S., Mody, S., et al. (2006). "Meaningful change and responsiveness in
common physical performance measures in older adults." Journal of the
American Geriatrics Society 54(5): 743-749. Find it on PubMed
Rasekaba, T., Lee, A., et al. (2009). "The six-minute walk test: a useful metric
for the cardiopulmonary patient." Internal Medicine Journal 39(8): 495-501.
Find it on PubMed
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
Scivoletto, G., Tamburella, F., et al. (2011). "Validity and reliability of the 10-m
walk test and the 6-min walk test in spinal cord injury patients." Spinal Cord.
Find it on PubMed
Steffen, T., Hacker, T., et al. (2002). "Age-and gender-related test
performance in community-dwelling elderly people: Six-Minute Walk Test,
Berg Balance Scale, Timed Up & Go Test, and gait speeds." Physical
Therapy 82(2): 128. Find it on PubMed
Steffen, T. and Seney, M. (2008). "Test-retest reliability and minimal
detectable change on balance and ambulation tests, the 36-Item Short-Form
Health Survey, and the Unified Parkinson Disease Rating Scale in people with
parkinsonism." Physical Therapy 88(6): 733. Find it on PubMed
Szekely, L., Oelberg, D., et al. (1997). "Preoperative predictors of operative
morbidity and mortality in COPD patients undergoing bilateral lung volume
reduction surgery." Chest 111(3): 550. 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., 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
Year published

1982

Instrument in PDF Format

Yes

Approval Status

Approved

Created at 10/30/2010 11:36 AM by Dawood Ali


Last modified at 10/25/2012 4:00 PM by Jason Raad
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