Reliability and validity of sit-to-stand test protocols in patients with coronary artery disease

Zheng Wang, Jianhua Yan, Shu Meng, Jiajia Li, Yi Yu, Tingting Zhang, Raymond C C Tsang, Doa El-Ansary, Jia Han, Alice Y M Jones, Zheng Wang, Jianhua Yan, Shu Meng, Jiajia Li, Yi Yu, Tingting Zhang, Raymond C C Tsang, Doa El-Ansary, Jia Han, Alice Y M Jones

Abstract

Background: Sit-To-Stand (STS) tests are reported as feasible alternatives for the assessment of functional fitness but the reliability of these tests in people with coronary artery disease (CAD) has not been reported. This study explored the test-retest reliability, convergent and known-groups validity of the five times, 30-sec and 1-min sit-to-stand test (FTSTS test, 30-s STS test and 1-min STS test respectively) in patients with CAD. The feasibility of applying these tests to distinguish the level of risk for cardiovascular events in CAD patients was also investigated.

Methods: Patients with stable CAD performed a 6MWT and 3 STS tests in random order on the same day. Receiver operating characteristic (ROC) curve analyses were conducted using STS test data to differentiate patients with low or high risk of cardiovascular events based on the risk level determined by distance covered in the 6MWT as > or ≤ 419 m. Thirty patients repeated the 3 STS tests on the following day.

Results: 112 subjects with diagnoses of atherosclerosis or post-percutaneous coronary intervention, or post-acute myocardial infarction (post-AMI) participated in the validity analysis. All 3 STS tests demonstrated moderate and significant correlation with the 6MWT (coefficient values r for the FTSTS, 30-s STS and 1-min STS tests were-0.53, 0.57 and 0.55 respectively). Correlations between left ventricular ejection fraction (LVEF) and all STS tests and between 6MWT and LVEF were only weak (r values ranged from 0.27 to 0.31). Subgroup analysis showed participants in the post-AMI group performed worse in all tests compared to non-myocardial infarction (non-MI) group. The area under the curve (AUC) was 0.80 for FTSTS (sensitivity: 75.0%, specificity: 73.8%, optimal cut-off: >11.7 sec), and the AUC, sensitivity, specificity and optimal cut-off for 30-s STS and 1-min STS test were 0.83, 75.0%, 76.2%, ≤ 12 repetitions and 0.80, 71.4%, 73.8%, ≤ 23 repetitions respectively. The intraclass correlation coefficients (ICC) for repeated measurements of the FTSTS, 30-s STS and 1-min STS tests were 0.96, 0.95 and 0.96 respectively, with the minimal detectable change (MDC95) computed to be 1.1 sec 1.8 repetitions and 3.9 repetitions respectively.

Conclusions: All STS tests demonstrated good test-retest reliability, convergent and known-groups validity. STS tests may discriminate low from high levels of risk for a cardiovascular event in patients with CAD.

Keywords: 6-minute walk test; coronary artery disease; discriminative ability; reliability; sit-to-stand; validity.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wang, Yan, Meng, Li, Yu, Zhang, Tsang, El-Ansary, Han and Jones.

Figures

Figure 1
Figure 1
Correlations between 6MWT and the 3 STS tests. FTSTS test: five times sit-to-stand test, 30-s STS test: 30-sec sit-to-stand test, 1-min STS test: 1-min sit-to-stand test, 6MWT: six-min walk test.
Figure 2
Figure 2
Intergroup comparison of STS tests and 6MWT performance. FTSTS test: five times sit-to-stand test, 30-s STS test: 30-sec sit-to-stand test, 1-min STS test: 1-min sit-to-stand test, 6MWT: six-min walk test, post-AMI: post-acute myocardial infarction. ** p < 0.01.

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