Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 11, pp 2625–2628 | Cite as

Reliability of the 6-min walk test after total knee arthroplasty

  • Thomas Linding JakobsenEmail author
  • Henrik Kehlet
  • Thomas Bandholm
Knee

Abstract

Purpose

The 6-min walk test is a simple clinical outcome measure, which has been used frequently to assess functional performance in many different patient groups, including patients with total knee arthroplasty (TKA). The 6-min walk test measures the maximal distance a subject is able to walk in 6 min. The reliability is unknown in patients with TKA. Therefore, the purpose of the study was to assess the reliability of the 6-min walk test in patients with recent TKA.

Methods

Thirty-four patients with TKA performed 2 test trials the same day, separated by a 1-h seated rest. To assess reliability, intra-class correlation coefficient (ICC2,1), standard error of measurement (SEM), and smallest real difference (SRD) were calculated.

Results

The patients walked on average 14.1 m longer at the second (397.2 m) compared to the first (383.1 m) test trial. The ICC2,1, SEM, and SRD were 0.97, 13.0, and 36.1 m, respectively.

Conclusions

The intra-tester reliability of the 6-min walk test was high in patients with TKA. The thresholds of the 6-min walk test to detect a real change are acceptable in research (SEM) and clinical settings (SRD). We recommend that the longest distance walked in 2 supervised test trials should be used.

Level of evidence

I.

Keywords

Total knee arthroplasty Functional outcome measure Reliability Disability evaluation 

Notes

Acknowledgments

We thank the physiotherapists working at the counties of Copenhagen, Frederiksberg and Hvidovre for helping recruiting patients; and Anette Paulsen and Rie Bjørnebo Rasmussen, BS students, Faculty of Physiotherapy at Metropolitan University College, Copenhagen, for collecting the data.

Conflicts of interest

The authors declare that they have no conflicts of interest. The study was supported in part by grants from The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty; Praksisfonden, Danish Regions and The Danish Foundation for Research in Physiotherapy. Neither of the funding sources had any influence on the design, execution, analysis, or reporting of the study.

References

  1. 1.
    American Thoracic Society (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRefGoogle Scholar
  2. 2.
    Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567PubMedCrossRefGoogle Scholar
  3. 3.
    Batterham AM, George KP (2003) Reliability in evidence-based clinical practice: a primer for allied health professionals. Phys Ther Sport 4:122–128CrossRefGoogle Scholar
  4. 4.
    Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL (2001) Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res 10:571–578PubMedCrossRefGoogle Scholar
  5. 5.
    Bernstein ML, Despars JA, Singh NP, Avalos K, Stansbury DW, Light RW (1994) Reanalysis of the 12-minute walk in patients with chronic obstructive pulmonary disease. Chest 105:163–167PubMedCrossRefGoogle Scholar
  6. 6.
    Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2:92–98PubMedGoogle Scholar
  7. 7.
    Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM (1982) Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 284:1607–1608CrossRefGoogle Scholar
  8. 8.
    de Groot IB, Bussmann HJ, Stam HJ, Verhaar JA (2008) Small increase of actual physical activity 6 months after total hip or knee arthroplasty. Clin Orthop Relat Res 466:2201–2208PubMedCrossRefGoogle Scholar
  9. 9.
    Denegar CR, Ball DW (1993) Assessing reliability and precision of measurement: an introduction to intraclass correlation and standard error of measurement. J Sport Rehabil 2:35–42Google Scholar
  10. 10.
    Eliasziw M, Young SL, Woodbury MG, Fryday-Field K (1994) Statistical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther 74:777–788PubMedGoogle Scholar
  11. 11.
    Farquhar S, Snyder-Mackler L (2010) The Chitranjan Ranawat Award: the nonoperated knee predicts function 3 years after unilateral total knee arthroplasty. Clin Orthop Relat Res 468:37–44PubMedCrossRefGoogle Scholar
  12. 12.
    Gibbons WJ, Fruchter N, Sloan S, Levy RD (2001) Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 21:87–93PubMedCrossRefGoogle Scholar
  13. 13.
    Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D (2005) Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord 6:3PubMedCrossRefGoogle Scholar
  14. 14.
    Kennedy DM, Stratford PW, Hanna SE, Wessel J, Gollish JD (2006) Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord 7:100PubMedCrossRefGoogle Scholar
  15. 15.
    Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH (2008) The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil 30:656–661PubMedCrossRefGoogle Scholar
  16. 16.
    Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L (2011) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplast 26:728–737CrossRefGoogle Scholar
  17. 17.
    Moffet H, Collet JP, Shapiro SH, Paradis G, Marquis F, Roy L (2004) 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 85:546–556PubMedCrossRefGoogle Scholar
  18. 18.
    Parent E, Moffet H (2002) Comparative responsiveness of locomotor tests and questionnaires used to follow early recovery after total knee arthroplasty. Arch Phys Med Rehabil 83:70–80PubMedCrossRefGoogle Scholar
  19. 19.
    Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, Snyder-Mackler L (2009) Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthr Rheum 61:174–183CrossRefGoogle Scholar
  20. 20.
    Rejeski WJ, Ettinger WH Jr, Schumaker S, James P, Burns R, Elam JT (1995) Assessing performance-related disability in patients with knee osteoarthritis. Osteoarthr Cartil 3:157–167PubMedCrossRefGoogle Scholar
  21. 21.
    Shrout PE (1998) Measurement reliability and agreement in psychiatry. Stat Methods Med Res 7:301–317PubMedCrossRefGoogle Scholar
  22. 22.
    Stillwell KM, Forman DE, McElwain D, Simpson C, Garber CE (1996) The 6 minute walk test for evaluation of functional capacity in elderly adults. Med Sci Sports Exerc 28:152CrossRefGoogle Scholar
  23. 23.
    Wu G, Sanderson B, Bittner V (2003) The 6-minute walk test: how important is the learning effect? Am Heart J 146:129–133PubMedCrossRefGoogle Scholar
  24. 24.
    Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L (2008) Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech (Bristol, Avon) 23:320–328CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Thomas Linding Jakobsen
    • 1
    • 2
    Email author
  • Henrik Kehlet
    • 3
  • Thomas Bandholm
    • 1
    • 4
    • 5
  1. 1.Clinical Research Centre (136)Copenhagen University HospitalHvidovreDenmark
  2. 2.Lundbeck Foundation Centre for Fast-track Hip and Knee ArthroplastyCopenhagen University HospitalHvidovreDenmark
  3. 3.Section for Surgical Pathophysiology, Juliane Marie Centre (4074)Copenhagen University HospitalCopenhagenDenmark
  4. 4.Department of Orthopedic Surgery (333)Copenhagen University Hospital, HvidovreHvidovreDenmark
  5. 5.Department of Physiotherapy (236)Copenhagen University Hospital, HvidovreHvidovreDenmark

Personalised recommendations