Am. J. Respir. Crit. Care Med., Vol 155, No. 4, 04 1997, 1278-1282.
Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients
DA Redelmeier, AM Bayoumi, RS Goldstein and GH Guyatt
Department of Medicine, The Program in Clinical Epidemiology and Health Care Research, University of Toronto, Ontario, Canada.
Functional status measurements are often difficult to interpret because
small differences may be statistically significant but not clinically
significant. How much does the Six Minute Walk test (6MW) need to differ to
signify a noticeable difference in walking ability for patients with
chronic obstructive pulmonary disease (COPD)? We studied individuals with
stable COPD (n = 112, mean age = 67 yr, mean FEV1 = 975 ml) and estimated
the smallest difference in 6MW distances that was associated with a
noticeable difference in patients' subjective comparison ratings of their
walking ability. We found that the 6MW was significantly correlated with
patients' ratings of their walking ability relative to other patients (r =
0.59, 95% confidence interval [CI]: 0.54 to 0.63). Distances needed to
differ by 54 m for the average patient to stop rating themselves as "about
the same" and start rating themselves as either "a little bit better" or "a
little bit worse" (95% CI: 37 to 71 m). We suggest that differences in
functional status can be statistically significant but below the threshold
at which patients notice a difference in themselves relative to others; an
awareness of the smallest difference in walking distance that is noticeable
to patients may help clinicians interpret the effectiveness of symptomatic
treatments for COPD.
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