Shoemaker Michael J, Curtis Amy B, Vangsnes Eric, Dickinson Michael G
Western Michigan University Interdisciplinary Health Sciences Program.
Cardiopulm Phys Ther J. 2012 Sep;23(3):5-15.
The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF).
THE PRESENT REVIEW INCLUDED TWO SEPARATE LITERATURE SEARCHES OF THE CINAHL AND MEDLINE DATABASES FOR ARTICLES THAT: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves.
Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40-45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI(95%) .855, 1.015).
A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.
本综述的目的是利用现有的已发表数据，对六分钟步行试验距离变化量（Δ6MWT）进行估计，该变化量代表慢性心力衰竭（CHF）患者临床上有意义的变化。
本综述包括对CINAHL和MEDLINE数据库进行两次独立的文献检索，检索的文章需满足：（1）报告CHF患者六分钟步行试验（6MWT）的组内相关系数（ICC）；（2）在针对CHF患者的运动干预随机对照试验（RCT）中，将6MWT与有氧能力或健康相关生活质量（HRQL）一起作为研究终点。利用ICC计算每项纳入研究在95%置信区间的最小可检测差异（MDD）。使用受试者工作特征（ROC）曲线分析每项纳入RCT中干预组和对照组内与有氧能力和HRQL相关的Δ6MWT效应量。
13篇文章报告了6MWT的ICC。基于这些数据计算的平均（标准差）MDD为43.1（16.8）米。18项RCT测量了6MWT以及有氧能力和/或HRQL。干预组中，40 - 45米的Δ6MWT与至少中等程度的有氧能力和HRQL效应量相关。使用ROC曲线区分干预组和对照组的Δ6MWT阈值显示，各阈值对应的敏感性/特异性如下：19米，94.4/83.3%；32米，83.3/94.4%；48米，44.4/100%（AUC = 0.935，p = 0.009，CI(95%) 0.855，1.015）。
约45米的Δ6MWT似乎超过了测量误差，并且与有氧能力和/或HRQL的显著变化相关。
