Daynes Enya, Barker Ruth E, Jones Amy V, Walsh Jessica A, Nolan Claire M, Man William D-C, Singh Sally J, Greening Neil J, Houchen-Wolloff Linzy, Evans Rachael A
Centre of Exercise and Rehabilitation Sciences, Leicester NIHR Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK.
Department of Respiratory Sciences, University of Leicester, Leicester, UK.
Eur Respir Rev. 2025 May 28;34(176). doi: 10.1183/16000617.0198-2024. Print 2025 Apr.
IMPORTANCE: The minimum important difference (MID) for field walking tests aims to improve interpretation of outcomes, but the volume and heterogeneity of MIDs for these tests is challenging. We aimed to determine the MID for the 6-min walk distance (6MWD), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with long-term conditions. METHODS: This systematic review included studies that generated a MID using an anchor-based approach in patients with long-term conditions for the 6MWD, ISWT or ESWT field walking tests. Studies were screened and data extracted by independent reviewers. Meta-analyses were performed using RevMan. RESULTS: 42 studies were included in the analyses, involving n=13 949 participants. Of these, 12 studies involving exercise as an intervention were included in the meta-analyses to produce MIDs, presented as mean (95% confidence interval). The MID for the 6MWD was 25 m (24-26 m) for respiratory conditions, 23 m (8-37 m) for cardiac conditions and 37 m (26-49 m) for neurological/musculoskeletal conditions. The MID for the ISWT was 48 m (39-57 m) for respiratory conditions and 70 m (55-85 m) for cardiac conditions. The MID for ESWT in COPD was 159 s (94-224 s). The pooled MID across conditions within exercise interventions was 26 m (22-40 m) for the 6MWD and 53 m (44-62 m) for the ISWT, with reasonable heterogeneity (I=48% and I=47%, respectively). CONCLUSION: We propose new MIDs for exercise interventions using anchor-based methodology in long‑term conditions for the 6MWD, ISWT and ESWT. These can be used internationally for meta‑analyses where studies have used different field walking tests, to optimise trial sample size calculations, and for clinical service benchmarking.
重要性：实地步行测试的最小重要差异（MID）旨在改善对结果的解释，但这些测试的MID数量和异质性具有挑战性。我们旨在确定患有长期疾病的成年人的6分钟步行距离（6MWD）、递增穿梭步行测试（ISWT）和耐力穿梭步行测试（ESWT）的MID。 方法：本系统评价纳入了在患有长期疾病的患者中，针对6MWD、ISWT或ESWT实地步行测试，采用基于锚定法得出MID的研究。由独立评审员筛选研究并提取数据。使用RevMan进行荟萃分析。 结果：42项研究纳入分析，涉及n = 13949名参与者。其中，12项涉及运动作为干预措施的研究纳入荟萃分析以得出MID，以均值（95%置信区间）呈现。6MWD在呼吸系统疾病中的MID为25米（24 - 26米），在心脏疾病中为23米（8 - 37米），在神经/肌肉骨骼疾病中为37米（26 - 49米）。ISWT在呼吸系统疾病中的MID为48米（39 - 57米），在心脏疾病中为70米（55 - 85米）。慢性阻塞性肺疾病（COPD）患者ESWT的MID为159秒（94 - 224秒）。运动干预中各疾病的6MWD合并MID为26米（22 - 40米），ISWT为53米（44 - 62米），异质性合理（分别为I = 48%和I = 47%）。 结论：我们针对患有长期疾病的患者，采用基于锚定法的运动干预措施，提出了6MWD、ISWT和ESWT的新MID。这些可在国际上用于研究使用不同实地步行测试的荟萃分析，以优化试验样本量计算，并用于临床服务基准测试。
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