Intra- and inter-rater reproducibility of the 6-minute walk test and the 30-second sit-to-stand test in patients with severe and very severe COPD

Henrik Hansen, Nina Beyer, Anne Frølich, Nina Godtfredsen, Theresa Bieler, Henrik Hansen, Nina Beyer, Anne Frølich, Nina Godtfredsen, Theresa Bieler

Abstract

Background: In patients with COPD, the 6-minute walk test (6MWT) and the 30-second sit-to-stand test (30sec-STS) are widely used as clinical outcome measures of walking capacity, lower limb muscle strength, and functional ability. Due to a documented learning effect, at least two trials are recommended for assessment. The aim of our study was to investigate the intra- and inter-rater reliability and agreement of the two tests in patients with severe and very severe COPD (FEV1 <50%).

Patients and methods: Fifty patients (22 females; mean [SD]: age 67 [9] years, FEV1 predicted 32 [9]%) were assessed with the 6MWT and the 30sec-STS twice by the same assessor on test-day 1 (T1) and by another assessor 7-10 days later on test-day 2 (T2).

Results: The 6MWT intra- and inter-rater reliability (intraclass correlation coefficient, ICC1.1) was 0.98 (lower limit 95% CI: 0.94) and 0.96 (lower limit 95% CI: 0.94), respectively, and agreement (standard error of the measurement, SEM) was 14.8 and 20.5 m, respectively. The 30sec-STS intra- and inter-rater reliability and agreement results were, respectively, ICC1.1 0.94 (lower limit 95% CI: 0.90) and 0.92 (lower limit 95% CI: 0.86), with SEM of 0.97 and 1.14 repetitions. There was no difference (95% CI: -5.3; 8.1) between the 6MWT distances on T1, while the mean walking distance improved 7.9 m (0.0 m; 15.8 m) from T1 to T2. Improvement on the same test date was less likely (OR: 3.6 [95% CI: 1.1; 11.8], Fisher's exact test, P=0.047) in patients who walked less than 350 m in the 6MWT. We found no clinically relevant learning effect in the 30sec-STS.

Conclusion: In patients with severe and very severe COPD the 6MWT and the 30sec-STS showed excellent intra- and inter-rater reliability and acceptable agreement. No learning effect was documented for the tests when performed on the same day. Our data suggest that in clinical practice using different assessors is acceptable, and that a single test trial may be sufficient to assess patients with severe and very severe COPD.

Keywords: COPD; exercise test; lower extremity; outcome assessment; reproducibility of results.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Assessment procedures at day 1 (T1) and day 2 (T2 reassessment). Abbreviations: Dyspnea, perceived dyspnea; end-, measure taken immediately after test completion; 6MWT, six-minute walk test; 30sec-STS, 30-second sit-to-stand test; SpO2, arterial oxygen saturation as measured by pulse oximetry.
Figure 2
Figure 2
Bland–Altman plots of the 6MWD and 30sec-STS. Notes: Mean difference between tests/or raters (dotted line) with limits of agreement 95% CI (black lines). The dashed line is the regression of change against the mean value. (A) 6MWD scores against 6MWD difference from a single rater at test-day 1 (T1). (B) 30sec-STS scores against 30sec-STS difference from a single rater at test-day 1 (T1). (C) 6MWD score difference obtained by two different raters on two separate test-days (T2 vs T1). (D) 30sec-STS score difference obtained by two different raters on two separate test-days (T2 vs T1). Abbreviations: 30sec-STS, 30-second sit-to-stand test; 6MWD, 6-minute walk distance.

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