Pecorelli Nicolò, Fiore Julio F, Gillis Chelsia, Awasthi Rashami, Mappin-Kasirer Benjamin, Niculiseanu Petru, Fried Gerald M, Carli Francesco, Feldman Liane S
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9.309, Montreal, QC, H3G 1A4, Canada.
Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada.
Surg Endosc. 2016 Jun;30(6):2199-206. doi: 10.1007/s00464-015-4478-1. Epub 2015 Aug 27.
Patients, clinicians and researchers seek an easy, reproducible and valid measure of postoperative recovery. The six-minute walk test (6MWT) is a low-cost measure of physical function, which is a relevant dimension of recovery. The aim of the present study was to contribute further evidence for the validity of the 6MWT as a measure of postoperative recovery after colorectal surgery.
This study involved a sample of 174 patients enrolled in three previous randomized controlled trials. Construct validity was assessed by testing the hypotheses that the distance walked in 6 min (6MWD) at 4 weeks after surgery is greater (1) in younger versus older patients, (2) in patients with higher preoperative physical status versus lower, (3) after laparoscopic versus open surgery, (4) in patients without postoperative complications versus with postoperative complications; and that 6MWD (5) correlates cross-sectionally with self-reported physical activity as measured with a questionnaire (CHAMPS). Statistical analysis was performed using linear regression and Spearman's correlation. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to guide the formulation of hypotheses and reporting of results.
One hundred and fifty-one patients who completed the 6MWT at 4 weeks after surgery were included in the analysis. All hypotheses tested for construct validity were supported by the data. Older age, poorer physical status, open surgery and occurrence of postoperative complications were associated with clinically relevant reduction in 6MWD (>19 m). There was a moderate positive correlation between 6MWD and patient-reported physical activity (r = 0.46).
This study contributes further evidence for the construct validity of the 6MWT as a measure of postoperative recovery after colorectal surgery. Results from this study support the use of the 6MWT as an outcome measure in studies evaluating interventions aimed to improve postoperative recovery.
患者、临床医生和研究人员都在寻找一种简便、可重复且有效的术后恢复测量方法。六分钟步行试验（6MWT）是一种低成本的身体功能测量方法，而身体功能是恢复的一个相关维度。本研究的目的是为6MWT作为结直肠手术后恢复情况测量方法的有效性提供更多证据。
本研究纳入了174名参与过三项先前随机对照试验的患者样本。通过检验以下假设来评估结构效度：术后4周时，6分钟步行距离（6MWD）在以下情况中更长：（1）年轻患者比老年患者；（2）术前身体状况较好的患者比身体状况较差的患者；（3）腹腔镜手术患者比开放手术患者；（4）无术后并发症的患者比有术后并发症的患者；以及（5）6MWD与通过问卷（CHAMPS）测量的自我报告身体活动呈横断面相关。使用线性回归和Spearman相关性进行统计分析。基于共识的健康测量工具选择标准（COSMIN）清单用于指导假设的制定和结果报告。
分析纳入了151名在术后4周完成6MWT的患者。所有用于检验结构效度的假设均得到数据支持。年龄较大、身体状况较差、开放手术以及术后并发症的发生与6MWD临床上相关的降低（>19米）有关。6MWD与患者报告的身体活动之间存在中度正相关（r = 0.46）。
本研究为6MWT作为结直肠手术后恢复情况测量方法的结构效度提供了更多证据。本研究结果支持在评估旨在改善术后恢复的干预措施的研究中使用6MWT作为结局指标。
