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Accompanied versus unaccompanied walking for continuous oxygen saturation measurement during 6-min walk test in COPD: a randomised crossover study.

ABSTRACT: The aim of this study was to determine if there is a difference in 6-min walk test (6MWT) distance when the assessor accompanies the patient to continuously measure peripheral oxygen saturation (S _pO₂ ) compared to the patient walking unaccompanied. We conducted a randomised crossover study to evaluate the impact of the assessor walking with the patient during the 6MWT (6MWT_with) versus the patient walking alone (6MWT_without). At the end of a pulmonary rehabilitation programme, each patient performed two 6MWTs in random order and separated by a 30-min rest. 49 patients with chronic obstructive pulmonary disease (COPD) (Global Initiative for Obstructive Lung Disease classification II-IV) were included. In a regression model adjusting for period and subject, accompanying the patient resulted in a lower walking distance (mean difference -9.1 m, 95% CI -13.9- -4.3, p=0.0004). Notably, six patients walked more than 30 m farther (minimal important difference) in one of the two conditions (6MWT_with: n=1, 6MWT_without: n=5). There were no between-sequence-group differences in heart rate, dyspnoea, leg fatigue and S _pO₂ . The median (interquartile range) number and duration of S _pO₂ signal artefacts were high but not different between the experimental conditions (6MWT_with: 17 (4-24), 34 s (7-113 s); 6 MWT_without: 11 (3-26), 24 s (4-62 s)). At a study population level, we observed a statistically significant difference in 6MWT distance between the two experimental conditions; however, the magnitude of difference was small and may not be clinically relevant. Nevertheless, in a clinical setting, unaccompanied walking resulted in a substantially higher walking distance in individual patients, pointing towards strictly standardised testing methodology, in particular in pre-post study designs.

SUBMITTER: Riegler TF

PROVIDER: S-EPMC8326679 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWalking speed is used to assess functional status, predict recovery, prescribe exercise, and track functional progress after stroke. Determining concurrent validity ensures that results from different tests of walking speed can be compared or used interchangeably. The GAITRite electronic walkway and the 10-m walk test (10MWT) are popular measurement tools of walking speed in the laboratory and in clinical settings, respectively.Research questionDo walking speeds in chronic stroke survivors measured with the 10-m walk test and GAITRite electronic walkway demonstrate concurrent validity?Methods77 participants with chronic stroke performed four trials of 10MWT and four trials of GAITRite-two trials at comfortable walking speed and two trials at maximal walking speed. Intraclass correlations [ICC (3,1), absolute agreement] and Bland-Altman plots were used to assess the relationship between gait speed from these two measures.ResultsWalking speed showed poor to good absolute agreement between 10MWT and GAITRite for comfortable walking speed [ICC: 0.77 (95% CI: 0.46, 0.89; P < 0.001)] and excellent absolute agreement for maximal walking speed [ICC: 0.94 (95% CI: 0.91, 0.96; P < 0.001)]. Mean difference value (systematic bias) was different from 0 for comfortable walking [10MWT was faster; P < 0.001 (95% CI: 0.05, 0.10)] but not for maximal walking [P = 0.16 (95% CI: -0.01, 0.04)]. Limits of agreement were broad (comfortable walking speed, 0.43; maximal walking speed, 0.37), and there was proportional bias at both speeds whereby participants who walked faster tended to have a faster walking speed during 10MWT vs. GAITRite (comfortable walking speed, R2 = 0.22, P < 0.001; maximal walking speed, R2 = 0.08, P = 0.01).SignificanceSystematic bias, proportional bias, and broad limits of agreement suggest that caution should be used when comparing walking speeds from 10MWT and GAITRite. It may not be appropriate to use them interchangeably. Conducting 10MWT and GAITRite tests at maximal walking speeds may allow more accurate comparisons between measures.

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Accompanied versus unaccompanied walking for continuous oxygen saturation measurement during 6-min walk test in COPD: a randomised crossover study.

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