The six-minute walk test is an excellent predictor of functional ambulation after total knee arthroplasty

BMC Musculoskeletal Disorders

Anthony ET Yeo²  Jack Crosbie³  Ian Andrew Harris²  Justine Marie Naylor²  Victoria Ko¹ 

[1] Whitlam Orthopaedic Research Centre, Sydney, Australia;Ingham Institute Applied Medical Research, Sydney, Australia;School of Science and Health, University of Western Sydney, Sydney, Australia

关键词: Self-reported outcomes;    Gait;   

Others  :  1132734
DOI  :  10.1186/1471-2474-14-145

 received in 2012-08-20, accepted in 2013-04-19,  发布年份 2013

【 摘 要 】

Background

The Six-minute walk (6MW) and Timed-Up-and-Go (TUG) are short walk tests commonly used to evaluate functional recovery after total knee arthroplasty (TKA). However, little is known about walking capacity of TKA recipients over extended periods typical of everyday living and whether these short walk tests actually predict longer, more functional distances. Further, short walk tests only correlate moderately with patient-reported outcomes. The overarching aims of this study were to compare the performance of TKA recipients in an extended walk test to healthy age-matched controls and to determine the utility of this extended walk test as a research tool to evaluate longer term functional mobility in TKA recipients.

Methods

The mobility of 32 TKA recipients one year post-surgery and 43 healthy age-matched controls were assessed using the TUG, 6MW and 30-minute walk (30MW) tests. The latter test was repeated one week later. Self-reported function was measured using the WOMAC Index and a physical activity questionnaire.

Results

30MW distance was significantly shorter amongst TKA recipients (mean 2108 m [95% CI 1837 to 2381 m]; Controls 3086 m [2981 to 3191 m], P < 0.001). Test-retest repeatability was high (ICC = 0.97, TKA; 0.96, Controls). Amongst TKA recipients, the 30MW distance correlated strongly with the shorter tests (6MW, r = 0.97, P < 0.001; TUG, r = −0.82, P < 0.001). Multiple regression modeling found 6MW distance to be the only significant predictor (P < 0.001) of 30MW distance, explaining 96% of the variability. The TUG test models were moderate predictors of WOMAC function (55%) and physical activity (36%) and were stronger predictors than 6MW and 30 MW tests.

Conclusions

Though TKA recipients are able to walk for 30 minutes one year post-surgery, their performance falls significantly short of age-matched norms. The 30MW test is strongly predicted by 6MW test performance, thus providing strong construct validity for the use of the 6MW test in the TKA population. Neither a short nor long walk test is a strong predictor of patient-reported function after TKA.

【 授权许可】

   
2013 Ko et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kramer JF, Speechley M, Bourne R, Rorabeck C, Vaz M: Comparison of clinic- and home-based rehabilitation programs after total knee arthroplasty. Clin Orthop Relat Res 2003, 410:225-234.
• [2]Moffet H, Collet JP, Shapiro SH, Paradis G, Marquis F, Roy L: Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. Arch Phys Med Rehabil 2004, 85(4):546-556.
• [3]Mizner RL, Petterson SC, Snyder-Mackler L: Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005, 35(7):424-436.
• [4]Kennedy DM, Stratford PW, Hanna SE, Wessel J, Gollish JD: Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord 2006, 7:100. BioMed Central Full Text
• [5]Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD: Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 2008, 88:22-32.
• [6]Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L: Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech 2008, 23(3):320-328.
• [7]Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, Snyder-Mackler L: Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Care Res 2009, 61(2):174-183.
• [8]Bade MJ, Kohrt WM, Stevens-Lapsley JE: Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010, 40(9):559-567.
• [9]Stratford PW, Kennedy DM, Maly MR, Macintyre NJ: Quantifying self-report measures' overestimation of mobility scores postarthroplasty. Phys Ther 2010, 90(9):1288-1296.
• [10]Steffen TM, Hacker TA, Mollinger L: 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. Phys Ther 2002, 82:128-137.
• [11]Rossi MD, Hasson S, Kohia M, Pineda E, Bryan W: Mobility and perceived function after total knee arthroplasty. J Arthroplasty 2006, 21(1):6-12.
• [12]Parent E, Moffet H: Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil 2002, 83(1):70-80.
• [13]Thomas SG, Pagura SM, Kennedy D: Physical activity and its relationship to physical performance in patients with end stage knee osteoarthritis. J Orthop Sports Phys Ther 2003, 33(12):745-754.
• [14]Kosak M, Smith T: Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. J Rehabil Res Dev 2005, 42(1):103-107.
• [15]Butland R, Pang J, Gross E, Woodcock A, Geddes D: Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J 1982, 284(6329):1607-1608.
• [16]Troosters T, Gosselink R, Decramer M: Six minute walking distance in healthy elderly subjects. Eur Respir J 1999, 14(2):270-274.
• [17]Bean JF, Kiely DK, Leveille SG, Herman S, Huynh C, Fielding R, Frontera W: The 6-minute walk test in mobility-limited elders: what is being measured? J Gerontol Series, A Biol Sci Med Sci 2002, 57(11):M751-M756.
• [18]Naylor JM, Harmer AR, Heard RC: Severe other joint disease and obesity independently influence recovery after joint replacement surgery: an observational study. Aust J Physiother 2008, 54(1):57-64.
• [19]Naylor JM, Ko V, Rougellis S, Green N, Hackett D, Magrath A, Barnett A, Kim G, White M, Nathan P: Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 1. J Eval Clin Pract 2012, 18(3):644-651.
• [20]Pollock ML, Gaesser GA, Butcher JD, Despres JP, Dishman RK, Franklin BA, Ewing Garger C: American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998, 30(6):975-991.
• [21]Pollock ML, Franklin BA, Balady GJ, Chaitman BL, Fleg JL, Fletcher B, Limacher M, Pina IL, Stein RA, Williams M: AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation 2000, 101(7):828-833.
• [22]Podsiadlo D, Richardson S: The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39(2):142-148.
• [23]Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D: Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord 2005, 6:3. BioMed Central Full Text
• [24]ATS statement: guidelines for the six-minute walk test Am J Respir Crit Care Med 2002, 166(1):111-117.
• [25]Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW: Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988, 15(12):1833-1840.
• [26]Armstrong T, Bauman A, Davies DM: Physical activity patterns of Australian adults. Results of the 1999 National Physical Activity Survey. Canberra: Australian Institute of Health and Welfare. In. Australian Institute of Health and Welfare: Canberra; 2000.
• [27]Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL: Defining the relationship between obesity and total joint arthroplasty. Obesity 2001, 9(3):219-223.
• [28]Foran JRH, Mont MA, Etienne G, Jones LC, Hungerford DS: The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg (American) 2004, 86(8):1609-1615.
• [29]Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D: Health-Related Quality of Life after Knee Replacement. Results of the Knee Replacement Patient Outcomes Research Team Study*. J Bone Joint Surg (American) 1998, 80(2):163-173.
• [30]Terwee CB, Mokkink LB, Steultjens MP, Dekker J: Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. Rheumatology 2006, 45(7):890-902.
• [31]Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Bélisle P, Liang MH, Ferland D, Phillips CB, Mahomed N: Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 2002, 46(12):3327-3330.
• [32]Enright PL, Sherrill DL: Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998, 158(5):1384-1387.
• [33]Gibbons WJ, Fruchter N, Sloan S, Levy RD: Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil Prev 2001, 21(2):87-93.
• [34]Ashe MC, Eng JJ, Miller WC, Soon JA: Disparity between physical capacity and participation in seniors with chronic disease. Med Sci Sports Exerc 2007, 39(7):1139.
• [35]DiPietro: Physical activity and aging health and function. 2001.
• [36]Prince S, Adamo K, Hamel M, Hardt J, Gorber S, Tremblay M: A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nut Phys Activ 2008, 5(1):56. BioMed Central Full Text
• [37]McClelland JA, Webster KE, Feller JA: Gait analysis of patients following total knee replacement: a systematic review. Knee 2007, 14(4):253-263.
• [38]Chen P, Cheng CK, Shang H, Wu J: Gait analysis after total knee replacement for degenerative arthritis. J Formos Med Assoc 1991, 90(2):160.
• [39]Alnahdi AH, Zeni JA, Snyder-Mackler L: Gait after unilateral total knee arthroplasty: Frontal plane analysis. J Orthop Res 2011, 29(5):647-652.
• [40]McClelland JA, Webster KE, Feller JA, Menz HB: Knee kinematics during walking at different speeds in people who have undergone total knee replacement. Knee 2011, 18(3):151-155.
• [41]Samson MM, Meeuwsen IB, Crowe A, Dessens JA, Duursma SA, Verhaar HJ: Relationships between physical performance measures, age, height and body weight in healthy adults. Age and ageing 2000, 29(3):235-242.
• [42]Lord SR, Menz HB: Physiologic, psychologic, and health predictors of 6-minute walk performance in older people. Arch Phys Med Rehabil 2002, 83(7):907-911.
• [43]Crosbie J, Naylor JM, Harmer AR: Six minute walk distance or stair negotiation? Choice of activity assessment following total knee replacement. Physiother Res Int 2010, 15(1):35-41.