Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery

Objective

The incremental shuttle walking test (ISWT) is widely used to assess patients with chronic obstructive pulmonary disease. We hypothesised that it would be an appropriate tool to assess patients with coronary heart disease following coronary artery bypass grafts. We therefore explored the reproducibility, validity and sensitivity of the ISWT following rehabilitation.

Design

Participants completed three ISWTs and an incremental treadmill test over 7 days. Eleven patients repeated the ISWT following rehabilitation.

Setting

Cardiac rehabilitation department.

Participants

Thirty-nine patients, 34 of whom were male, with a mean age of 61.2 years (S.D. 8.5), 6-8 weeks after coronary artery bypass graft surgery.

Main outcome measures

Maximum oxygen uptake (O_2 peak, ml/min/kg) and ISWT.

Results

Mean (S.D.) distances for the three ISWTs were 448 m (137.8), 487 m (147.6) and 481 m (138.2). There was no statistically significant difference between the three ISWTs. The mean difference between Tests 1 and 2 was 42.8 m (95% confidence interval 59.1-26.5 m) compared with 1.7 m (95% confidence interval −1.86-5.29) between Tests 2 and 3. The mean O_2 peak was 21.0 (S.D. 4.5) ml/min/kg. There was a significant relationship between the results for the three ISWTs and O_2 peak (r = 0.79, r = 0.86 and r = 0.87 for Tests 1-3, respectively). Following rehabilitation, there was a significant increase in the distance walked; the mean difference between the second ISWT and the post-rehabilitation ISWT was 81.8 m (95% confidence interval 53.2-110.4, P < 0.001).

Conclusions

The ISWT correlates well with O_2 peak and is a reliable measure of cardiorespiratory fitness in this population after one practice walk.     

A study to determine the reliability of an ankle dorsiflexion weight-bearing device

Objectives

To investigate the inter-observer and intra-observer reliability of measurement of ankle movement during a weight-bearing dorsiflexion lunge in healthy and injured groups.

Setting

Defence Medical Rehabilitation Centre, UK.

Participants

Seventeen healthy subjects, 11 subjects with ankle injuries and three trained observers.

Design

Each observer assessed subjects on two separate test days, 7 days apart. Each measurement was repeated six times and the results were averaged. Limits of agreement and intra-class correlation coefficients were calculated to give a measure of reliability.

Main outcome measures

A measurement tool designed at the Defence Medical Rehabilitation Centre, UK.

Results

Intra-observer 95% limits of agreement ranged from ±3.30 to ±3.66 cm for the healthy group and from ±2.35 to ±3.85 cm for patients. The inter-observer limits of agreement ranged from ±1.57 to ±2.65 cm for healthy subjects and from ±0.87 to ±3.46 cm for patients.

Conclusions

Results indicate acceptable inter-observer and intra-observer reliability for use of this rehabilitation assessment tool to measure the weight-bearing dorsiflexion lunge range of ankle motion when results are averaged over six repetitions.     

Predicting Home and Community Walking Activity in People With Stroke

Fulk GD, Reynolds C, Mondal S, Deutsch JE. Predicting home and community walking activity in people with stroke.

Objective

To determine the ability of the 6-minute walk test (6MWT) and other commonly used clinical outcome measures to predict home and community walking activity in high-functioning people with stroke.

Design

Cross-sectional.

Setting

Outpatient physical therapy clinic.

Participants

Participants (N=32) with chronic stroke (n=19; >6mo poststroke) with self-selected gait speed (GS) faster than .40m/s and age-matched healthy participants (n=13).

Interventions

Not applicable.

Main Outcome Measures

Independent variables: 6MWT, self-selected GS, Berg Balance Scale (BBS), lower extremity motor section of the Fugl-Meyer Assessment, and Stroke Impact Scale. Dependent variable: average steps taken per day during a 7-day period, measured using an accelerometer.

Results

6MWT, self-selected GS, and BBS were moderately related to home and community walking activity. The 6MWT was the only predictor of average steps taken per day; it explained 46% of the variance in steps per day.

Conclusions

The 6MWT is a useful outcome measure in higher functioning people with stroke to guide intervention and assess community walking activity.     

Validating the six-minute walk test as a measure of recovery after elective colon resection surgery

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery.

Objective

To provide evidence for construct and longitudinal validity of the six-minute walk test (6MWT) as a measure of postsurgical recovery.

Design

Data from a randomized clinical trial.

Setting

A major teaching hospital in a Canadian urban city.

Participants

Patients (N=63) undergoing elective colon resection.

Interventions

Not applicable.

Main Outcome Measures

Functional walking capacity was measured using the 6MWT at before surgery and at 3 and 6 weeks after surgery.

Results

At 3 weeks, 26 (41%) patients recovered to baseline or greater on the 6MWT distance, and 37 (59%) were at baseline or better by 6 weeks postdischarge. At all time points, the 6MWT distance correlated with age, the American Society of Anesthesiologists (ASA) score of surgical risk, albumin, the physical function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the physical component summary score of the SF-36. Baseline 6MWT distance correlated with postoperative 6MWT recovery, and baseline SF-36 and ASA were associated with postoperative recovery. Patients with intraoperative complications had a clinically relevant lower 6MWT than those without complications at all time points.

Conclusions

This study provides evidence for construct validity and sensitivity to change for the 6MWT as a measure of surgical recovery.     

Gender differences in patient perceptions of involvement in myocardial infarction care

Background

Gender differences in the clinical presentation, treatment and outcomes of myocardial infarction (MI) have been demonstrated. However, few studies have examined gender differences in patients' perceptions of involvement in MI care, and whether differing levels of involvement might be associated with gender differences in treatment and outcome.

Aim

To examine possible gender differences in MI patients' perceptions of their involvement during hospitalization.

Methods

Questionnaire study conducted in 2005-2006 among MI patients under the age of 75 at eleven hospitals. Patient ratings of their involvement during hospitalization were analyzed for age-stratified gender differences.

Results

Younger (< 70 years of age) female MI patients placed significantly more value on shared decision-making than younger (< 70) men. More than one third of patients would have liked to be more involved in their care during hospitalization and discharge planning, with women significantly more dissatisfied than men. Significantly fewer younger female patients discussed secondary preventive lifestyle changes with cardiology staff prior to hospital discharge.

Conclusion

Significant age-specific gender differences exist in MI patient ratings of, and satisfaction with, involvement during hospitalization. Further study is needed regarding the possible role of involvement in the recognized gender differences in the treatment and outcomes of MI.     

Validity of the 6-minute walk test for assessing heart rate recovery after an exercise-based cardiac rehabilitation programme

Objectives

To compare heart rate responses in the 6-minute walk test and the treadmill exercise test before and after an exercise-based cardiac rehabilitation programme.

Design

Prospective cohort study.

Setting

Hospital-based cardiac rehabilitation programme in Hong Kong.

Participants

Thirty patients (mean age 62.1 ± 8.5 years, 20 males) with stable ischaemic heart disease.

Interventions

Eight-week exercise-based cardiac rehabilitation programme involving upper and lower limb aerobic and resistance training.

Main outcome measures

Six-minute walk test and treadmill exercise test before and after the exercise programme.

Results

Comparing parameters before and after the exercise programme, the peak heart rate in the 6-minute walk test increased (median of 105 beats per minute (bpm), interquartile range 96.8-116.5 versus 110 bpm, interquartile range 100.5-124.5, P = 0.006), while heart rate recovery improved in each 30-second interval of a 2-minute recovery period. The distance covered during the 6-minute walk increased from a mean of 486.3 m (±standard deviation 113.9 m) to 552.5 m (±standard deviation 111.9 m) (P < 0.001). Rating of perceived exertion during the 6-minute walk test decreased from a median of 14 (interquartile range 13-15) to 13 (interquartile range 13-13) (P = 0.001). Heart rate recovery following treadmill exercise testing improved during the 30-second periods from 60 to 90 seconds and from 90 to 120 seconds of recovery. Metabolic equivalents increased during treadmill testing from a median of 7.0 (interquartile range 5.8-8.6) to 8.6 (interquartile range 7-8.6) (P < 0.001).

Conclusions

Both treadmill exercise and 6-minute walk tests demonstrated improvements in heart rate recovery and increases in achieved workload following exercise training. This suggests that the 6-minute walk test is a valid tool to assess heart rate recovery following such a programme.     

Effect of spectators on the performance of a physiotherapy exercise

Objective

To investigate the effect of spectators on the performance of a physiotherapy exercise.

Design

Observational study.

Setting

Research laboratory, Trinity College Dublin.

Participants

Forty adult volunteer subjects (36 females, four males). As there were only four males, these were excluded from the analysis.

Interventions

Subjects were observed and timed while performing single leg stance in two conditions 48 hours apart; once with the investigator present (investigator condition) and once with the investigator and three spectators present (spectator condition).

Main outcome measure

Duration of single leg stance in seconds.

Results

The mean duration of single leg stance, for females, under the investigator condition was 173 seconds [95% confidence interval (CI) 131 to 214], while that of the spectator condition was 168 seconds (95%CI 128 to 208). The mean difference between the two conditions was 5 seconds (95%CI −21 to 31). This was not statistically significant using a paired t-test (P = 0.686).

Conclusions

Female performance of a straightforward exercise such as single leg stance was not affected by the presence of three spectators.     

A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain

Objectives

To assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP).

Design

A randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment.

Setting

An outpatient physiotherapy department.

Participants

One hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group.

Interventions

Both groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound.

Main outcome measures

Pain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography.

Results

Following treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1-26.8], functional disability (mean 8%, 95% CI 2-13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5-13.4; extension: mean 3.4 mm, 95% CI 1.0-5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24-14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5-7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1-0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up.

Conclusions

Although improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up.     

Improvement in aerobic fitness during rehabilitation after hip fracture

Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture.

Objective

To evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation.

Design

Randomized controlled trial using a convenience sample.

Setting

An inpatient rehabilitation unit.

Participants

Twenty older patients (age, 81.3±7.2y; 14 women).

Intervention

Patients were randomly assigned to a control group (n=10) or a training group (n=10). Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation (mean length of stay, 32.9±5.3d). Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks.

Main Outcome Measure

Peak oxygen consumption (Vo₂peak).

Results

Vo₂peak increased significantly in the training group (8.9±1.4 to 10.8±1.7mL·kg⁻¹·min⁻¹) and did not change in the control group (8.9±1.2 to 8.8±1.6mL·kg⁻¹·min⁻¹). At discharge, both groups were significantly improved in all functional outcome measures (Timed Up & Go [TUG] test, Berg Balance Scale [BBS], FIM instrument, two-minute walk test [2MWT], and ten-minute walk test [10MWT]). The training group performed significantly better in mobility (TUG, 2MWT, 10MWT) and balance (BBS) compared with the control group. There was a significant correlation between Vo₂peak and the 2MWT (r=.81) and 10MWT (r=.85) in the training group at discharge.

Conclusions

The upper-body exercise program had a significant effect on aerobic power. Our results suggest that aerobic endurance exercise should be integrated into standard rehabilitation to enhance patients’ aerobic fitness and mobility after hip fracture surgery.     

Age-Associated Changes in Motor Unit Physiology: Observations From the Baltimore Longitudinal Study of Aging

Ling SM, Conwit RA, Ferrucci L, Metter EJ. Age-associated changes in motor unit physiology: observations from the Baltimore Longitudinal Study of Aging.

Objective

To examine motor unit characteristics (size and firing rate) associated with aging.

Design

Cross-sectional, observational.

Setting

Community.

Participants

Baltimore Longitudinal Study of Aging participants (N=102), aged 22.2 to 94.1 years, were studied.

Interventions

Not applicable.

Main Outcome Measures

Surface-represented motor unit size and firing rate were collected from the vastus medialis during knee extension at 10%, 20%, 30%, and 50% of each subject's maximum isometric voluntary contraction (MVC).

Results

MVC declined with older age (P<.0001). Adjusting for differences in MVC, both firing rate and motor unit size per newton force generated began to increase in the 6th decade of life. Motor unit size increased per newton force to a greater extent than firing rate. Those over the age of 75 years also activated significantly larger motor units per unit force (P=.04). Relative to force generated, the average firing rate began increasing at 57.8±3.4 years and between 50.2 and 56.4 years (±4y) for motor unit size.

Conclusions

The size of motor units and firing rates used to achieve a given force changes with age, particularly after middle age. Whether these changes precede, follow, or occur concurrent to age-related modifications in muscle structure and contractile properties or sarcopenia is not known.     

Exploring Actical Accelerometers as an Objective Measure of Physical Activity in People With Multiple Sclerosis

Kayes NM, Schluter PJ, McPherson KM, Leete M, Mawston G, Taylor D. Exploring Actical accelerometers as an objective measure of physical activity in people with multiple sclerosis.

Objective

To assess the feasibility, acceptability, and psychometric properties of Actical accelerometers in people with multiple sclerosis (MS).

Design

Participants attended 2 testing sessions 7 days apart in which they completed 6 activities ranging in intensity while wearing an Actical accelerometer and Polar heart rate monitor. Perceived exertion was recorded after each activity.

Setting

University research center.

Participants

People (N=31) with a definite diagnosis of MS were purposefully selected, aiming for diversity in level of reported disability, age, sex, and type of MS.

Interventions

Not applicable.

Main Outcome Measures

Actical accelerometer, Polar S810i and RS800sd heart rate monitors, Borg rating of perceived exertion, six-minute walk test (6MWT), 30-second chair stand test.

Results

Accelerometers had good feasibility and acceptability in people with MS. Test-retest reliability was poor for sedentary and free-living activities, with low to moderate intraclass correlation coefficients (.00-.75), but was better for more vigorous or rhythmic activities (.85-.90). Bland-Altman 95% limits of agreement for average accelerometer counts were wide, ranging from ±16 (newspaper reading) to ±1330 (6MWT). Validity was not established with 95% prediction intervals showing high variability for all activities.

Conclusions

The psychometric problems highlighted here suggest Actical accelerometers should be used with caution in people with MS as a measure of physical activity, particularly when measuring comparatively sedentary or free-living activities.     

A study to compare the effects of massage and static touch on experimentally induced pain in healthy volunteers

Objective

To investigate the hypoalgesic effects of massage on experimental pain.

Design

A cross-over intervention study separated by a 24-hour washout period. During each experiment, participants completed five cold-induced pain tests, two before the intervention and three during the intervention. During each test, participants immersed their hand in iced water and reported the first sensation of pain and pain intensity after a further 30 seconds.

Setting

Laboratory setting.

Participants

A volunteer sample of 30 university staff and students without known pathology, recruited from noticeboard advertisements.

Interventions

Participants received massage in one experiment and static touch in the other experiment. Interventions were administered to the ipsilateral arm for 4 minutes immediately before the hand was immersed in iced water.

Main outcome measures

Time to pain threshold and the odds of a reduction in pain intensity and an increase in pain relief.

Results

A mixed model analysis was used to establish how measures varied, according to baseline, during static touch and during massage. Massage increased the pain threshold by a factor of 1.08 (95% confidence interval 0.99-1.17) compared with static touch, but this failed to reach statistical significance (P = 0.088). Massage was more likely to result in a report of low pain intensity than static touch (odds ratio 0.26, 95% confidence interval 0.10-0.71, P = 0.007). Massage was more likely to result in a state of high pain relief than static touch (odds ratio 7.7, 95% confidence interval 3.0-19.8, P < 0.001).

Conclusion

Massage produced hypoalgesic effects on experimental pain in healthy volunteers.     

Feasibility of motor capability training at home in children with acquired brain injury

Objectives

Acquired brain injury (ABI) requires an extended recovery time and residual signs may be observed years after discharge. Supervised home-based motor training may present a viable option for continuing treatment of adult patients, but little information is available on home-based treatment in children. This study assessed the feasibility of home practice in children with ABI (1 or more years post-trauma). The efficacy of the programme was also evaluated.

Design

A non-randomised, self-control study with control and intervention periods.

Setting

Home-based exercise programme.

Participants

Nineteen children (mean age 12.5 ± 3.1 years).

Interventions

A 4-week daily training programme of step-up and sit-stand-sit exercises.

Main outcome measures

Feasibility was assessed by the number of participants who completed the programme. Efficacy was evaluated at different stages using 10-metre walking and 2-minute walking tests, and the balance subitems of the Bruininks-Oseretsky Test of Motor Proficiency. An energy expenditure index was calculated for walking. Performance scores were used to assess balance.

Results

Nine participants completed the study. The mean number of training sessions was 22 ± 8 of the 30 sessions originally scheduled. Major differences were noted between the experimental stages. Walking speed, endurance and balance improved significantly during the intervention period.

Conclusions

Continuing exercising at home may be a feasible and efficient option for a considerable proportion of ABI children who are compliant with a simple but challenging exercise programme. A randomised controlled trial with a larger sample is now required.     

Early-career burnout among new graduate nurses: A prospective observational study of intra-individual change trajectories

Background

Newly qualified and inexperienced nurses are at particular risk of suffering emotional exhaustion and burnout in unsupportive practice environments. Despite new nurses’ potential vulnerability, development of burnout after graduation has rarely been studied longitudinally and in relation to demographic and educational characteristics prior to working life entry, i.e. during education.

Objectives

To identify and compare typical change trajectories (i.e. common patterns of intra-individual development) in burnout symptoms for new graduate nurses annually over a three-year period, during which there was reason to believe that this group was especially vulnerable.

Design

A prospective longitudinal and national cohort of 1153 nurses within the population-based LANE study (Longitudinal Analyses of Nursing Education), where new graduate nurses were assessed four times annually, i.e. in their final year of nursing education and three times post graduation (after 1, 2 and 3 years).

Participants

A longitudinal sample of 997 respondents was prospectively followed.

Methods

Within-group changes in burnout levels were analysed using a repeated-measures analysis of variance, and cluster analytic techniques were used to identify typical trajectories of burnout.

Results

At group level, mean levels of burnout were rather stable across time. However, underlying these levels we identified eight change trajectories, explaining 74% of all individual variation; seven of them reflected significant changes across time. Almost every fifth nurse reported extremely high levels of burnout at some point during their first three years after graduation. Changes in burnout levels were accompanied by concurrent changes in depressive symptoms and intention to leave the profession. This study also showed that negative development of burnout was predicted by not feeling well prepared for a nursing job, lacking study interest, high levels of performance-based self-esteem and depressive mood in the final year of education.

Conclusions

An investigation of burnout symptoms over time disclosed numerous development patterns, some of which were stable while others changed significantly. Hence, this study gave a more nuanced picture of burnout development among new graduate nurses, highlighted by eight different trajectories. Regarding the time frame, nearly every second new graduate showed a significant increase in levels of burnout during their second year post graduation.     

Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients

Objective

The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients’ functional capacity during cardiac rehabilitation. However, studies have only assessed its test-retest reliability in the short term. The purpose of this study was to examine long-term test-retest reliability of the ISWT in clinically stable cardiac patients.

Design

Test-retest reliability assessment.

Setting

Continuous, community-based phase IV cardiac rehabilitation centre.

Participants

Thirty patients with cardiovascular disease (15 males, 15 females; age 55 to 80 years) volunteered to participate in the study.

Interventions

Participants undertook two ISWTs, a minimum of 8 weeks apart.

Main outcome measures

ISWT performance in metres.

Results

Overall, the mean distance walked in the pre-test was 502 ± 161 m and this did not differ from test to retest. The intraclass correlation coefficient was 0.80, indicating good test-retest reliability. Using the Bland and Altman method, there was a small mean test-retest difference (−7 m). The 95% limits of agreement were large, ranging from −203 m to 189 m.

Conclusions

Over long test-retest durations, there appears to be no learning effect in the ISWT, negating the need for a practice walk. The long-term random variation in the ISWT test is larger than in previous studies, probably due to greater physiological and psychological variation in the participants over 8 weeks compared with that seen in day-to-day testing. Factors influencing long-term test-retest reliability of the ISWT require further elucidation.     

Objective monitoring of adherence with home exercise training during pulmonary rehabilitation for chronic obstructive pulmonary disease

Objectives

Outpatient pulmonary rehabilitation relies on the patient completing bouts of unsupervised exercise at home. The aim of this study was to monitor adherence with a home walking programme using activity monitors.

Design

The sensitivity and reliability of five activity monitors were initially established at speeds at which patients are advised to walk. Thereafter, 18 patients with established chronic obstructive pulmonary disease attending pulmonary rehabilitation were recruited. All patients were required to wear a small device around their waist for two, 7-day periods during the 7-week course of rehabilitation. During this time, patients also completed a home diary card. Adherence was monitored by frequency, duration and intensity of walks.

Setting

Pulmonary Rehabilitation Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.

Results

The activity monitors were able to clearly discriminate varying walking speeds and were reproducible at each pre-selected speed (P < 0.05). However, between-monitor comparison was not reproducible at the pre-determined speeds. Individually prescribed walking speeds for home training ranged from 1.76 to 4.83 km/hour. As a group, only two patients failed to achieve 100% of total adherence. Adherence for the individual components varied widely.

Conclusion

Activity monitor technology appears to be able to discriminate individually prescribed walking speeds that allow home walking programmes to be monitored.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

A review of the six-minute walk test: Its implication as a self-administered assessment tool

Background

Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity.

Aim

The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test.

Method

The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated.

Conclusions

Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.     

Validation transculturelle de l’Oswestry disability index en français

Aim

The aim of this study was to interpret and validate a French version of the Oswestry disability index (ODI), using a cross-cultural validation method. The validity and reliability of the questionnaire was assessed in order to ensure the psychometric characteristics.

Method

The cross-cultural validation was carried out according to Beaton's methodology. The study was conducted with 41 patients suffering from low back pain. The correlation between the ODI and the Roland-Morris disability questionnaire (RMDQ), the medical outcome survey short form-36 (MOS SF-36) and a pain visual analogical scale (VAS) was assessed.

Results

The validity of the Oswestry questionnaire was studied using the Cronbach Alpha coefficient calculation: 0.87 (n = 36). The significant correlation between the ODI and RMDQ was 0.8 (P < 0.001, n = 41) and 0.71 (P < 0.001, n = 36) for the pain VAS. The correlation between the ODI and certain subscales (physical functioning 0.7 (P < 0.001, n = 41), physical role 0.49 et bodily pain 0.73 (P < 0.001, n = 41)) of the MOS SF-36 were equally significant. The reproducibility of the ODI was calculated using the Wilcoxon matched pairs test: there was no significant difference for eight out of ten sections or for the final score.

Conclusion

This French translation of the ODI should be considered as valid and reliable. It should be used for any future clinical studies carried out using French language patients. Complimentary studies must be completed in order to assess its sensitivity to change in the event of any modifications in the patients functional capacity.