成人哮喘患者6分钟步行测试的信度、结构效度和决定因素
2022/12/21
摘要
简介和目标：目前关于哮喘患者6分钟步行试验（6MWT）测量特性的知识有限。因此，本研究的目的是评估6MWT的重测可靠性、测量误差和结构效度，并确定哮喘患者6分钟步行距离（6MWD）的决定因素。
患者和方法：本研究回顾性分析了201例未进行肺康复评估的哮喘患者（年龄61±12岁，42%为男性，FEV1预测值为78±27%）。患者在随后的几天进行了两次6MWT，采用30m的直线行走路线。其他测量包括静息呼吸困难、最大运动能力、身体组成、肺功能、肺和股四头肌肌力以及焦虑和抑郁症状。测量误差（绝对可靠性）使用标准测量误差（SEM）、95%置信区间（MDC95%）的最小可检测变化以及Bland和Altman 95%的一致性限进行测试，而重测可靠性（相对可靠性）和结构效度分别使用类内相关系数（ICC2,1）和相关性进行评估。
结果：6MWD显示出优异的重测信度（ICC2,1:0.91）。第二次6MWT后6MWD的平均变化为18m（95%CI 11-24m），73%的患者在第二次测试中走得更远。6MWT的SEM和MDC95%分别为35m和98m。最佳6MWD与CPET期间的峰值氧摄取和静息呼吸困难密切相关（r=0.61-0.64），与身体成分、肺功能、呼吸和股四头肌肌力以及焦虑和抑郁症状有从无到中度相关（r=0.02-0.45）。多元线性回归能够确定最大工作量、BMI、旋转器使用、最大呼气压力、FEV1和DLCO是最佳6MWD的独立决定因素（R2=0.58）。
结论：6MWT在哮喘患者中被认为是可靠和有效的，这加强了其临床应用。然而，大多数患者在第二个6MWT中表现出了相当大的学习效果，为执行两次6MWT提供了有力的理由。
Test-retest reliability, construct validity and determinants of 6-minute walk test performance in adult patients with asthma
R Meys, S M J Janssen, F M E Franssen, A W Vaes, A A F Stoffels, H W H van Hees, B van den Borst, P H Klijn, C Burtin, A J van 't Hul, M A Spruit
Abstract
Introduction and objectives: Current knowledge regarding the measurement properties of the 6-minute walk test (6MWT) in patients with asthma is limited. Therefore, the aim of this study was to assess the test-retest reliability, measurement error and construct validity of the 6MWT and identify determinants of 6-minute walk distance (6MWD) in patients with asthma.
Patients and methods: 201 asthma patients referred for pre-pulmonary rehabilitation assessment, were retrospectively analyzed (age 61±12 years, 42% male, FEV1 78±27% predicted). Patients performed two 6MWTs on subsequent days using a 30 m straight walking course. Other measurements included resting dyspnea, maximal exercise capacity, body composition, pulmonary function, pulmonary and quadriceps muscle strength and symptoms of anxiety and depression. Measurement error (absolute reliability) was tested using standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95%) and Bland and Altman 95% limits of agreement, whereas test-retest reliability (relative reliability) and construct validity were assessed using the intra-class correlation coefficient (ICC2,1) and correlations, respectively.
Results: The 6MWD showed excellent test-retest reliability (ICC2,1: 0.91). The mean change in 6MWD after the second 6MWT was 18m (95%CI 11-24m), with 73% of the patients walking further in the second test. The SEM and MDC95% for the 6MWT were 35 m and 98 m, respectively. The best 6MWD correlated strongly with peak oxygen uptake during CPET and resting dyspnea (r = 0.61-0.64) and had no-to-moderate correlations with body composition, pulmonary function, respiratory and quadriceps muscle strength and symptoms of anxiety and depression (r = 0.02-0.45). Multiple linear regression was able to identify maximal workload, BMI, rollator use, maximal expiratory pressure, FEV1 and DLCO as independent determinants of the best 6MWD (R2 = 0.58).
Conclusions: The 6MWT was considered to be reliable and valid in patients with asthma, which strengthens its clinical utility. However, the majority of patients demonstrated a considerable learning effect in the second 6MWT, providing a strong rationale for performing two 6MWTs.
简介和目标：目前关于哮喘患者6分钟步行试验（6MWT）测量特性的知识有限。因此，本研究的目的是评估6MWT的重测可靠性、测量误差和结构效度，并确定哮喘患者6分钟步行距离（6MWD）的决定因素。
患者和方法：本研究回顾性分析了201例未进行肺康复评估的哮喘患者（年龄61±12岁，42%为男性，FEV1预测值为78±27%）。患者在随后的几天进行了两次6MWT，采用30m的直线行走路线。其他测量包括静息呼吸困难、最大运动能力、身体组成、肺功能、肺和股四头肌肌力以及焦虑和抑郁症状。测量误差（绝对可靠性）使用标准测量误差（SEM）、95%置信区间（MDC95%）的最小可检测变化以及Bland和Altman 95%的一致性限进行测试，而重测可靠性（相对可靠性）和结构效度分别使用类内相关系数（ICC2,1）和相关性进行评估。
结果：6MWD显示出优异的重测信度（ICC2,1:0.91）。第二次6MWT后6MWD的平均变化为18m（95%CI 11-24m），73%的患者在第二次测试中走得更远。6MWT的SEM和MDC95%分别为35m和98m。最佳6MWD与CPET期间的峰值氧摄取和静息呼吸困难密切相关（r=0.61-0.64），与身体成分、肺功能、呼吸和股四头肌肌力以及焦虑和抑郁症状有从无到中度相关（r=0.02-0.45）。多元线性回归能够确定最大工作量、BMI、旋转器使用、最大呼气压力、FEV1和DLCO是最佳6MWD的独立决定因素（R2=0.58）。
结论：6MWT在哮喘患者中被认为是可靠和有效的，这加强了其临床应用。然而，大多数患者在第二个6MWT中表现出了相当大的学习效果，为执行两次6MWT提供了有力的理由。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Pulmonology. 2022 Dec 2;S2531-0437(22)00257-4. doi: 10.1016/j.pulmoe.2022.10.011.)
(Pulmonology. 2022 Dec 2;S2531-0437(22)00257-4. doi: 10.1016/j.pulmoe.2022.10.011.)
Test-retest reliability, construct validity and determinants of 6-minute walk test performance in adult patients with asthma
R Meys, S M J Janssen, F M E Franssen, A W Vaes, A A F Stoffels, H W H van Hees, B van den Borst, P H Klijn, C Burtin, A J van 't Hul, M A Spruit
Abstract
Introduction and objectives: Current knowledge regarding the measurement properties of the 6-minute walk test (6MWT) in patients with asthma is limited. Therefore, the aim of this study was to assess the test-retest reliability, measurement error and construct validity of the 6MWT and identify determinants of 6-minute walk distance (6MWD) in patients with asthma.
Patients and methods: 201 asthma patients referred for pre-pulmonary rehabilitation assessment, were retrospectively analyzed (age 61±12 years, 42% male, FEV1 78±27% predicted). Patients performed two 6MWTs on subsequent days using a 30 m straight walking course. Other measurements included resting dyspnea, maximal exercise capacity, body composition, pulmonary function, pulmonary and quadriceps muscle strength and symptoms of anxiety and depression. Measurement error (absolute reliability) was tested using standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95%) and Bland and Altman 95% limits of agreement, whereas test-retest reliability (relative reliability) and construct validity were assessed using the intra-class correlation coefficient (ICC2,1) and correlations, respectively.
Results: The 6MWD showed excellent test-retest reliability (ICC2,1: 0.91). The mean change in 6MWD after the second 6MWT was 18m (95%CI 11-24m), with 73% of the patients walking further in the second test. The SEM and MDC95% for the 6MWT were 35 m and 98 m, respectively. The best 6MWD correlated strongly with peak oxygen uptake during CPET and resting dyspnea (r = 0.61-0.64) and had no-to-moderate correlations with body composition, pulmonary function, respiratory and quadriceps muscle strength and symptoms of anxiety and depression (r = 0.02-0.45). Multiple linear regression was able to identify maximal workload, BMI, rollator use, maximal expiratory pressure, FEV1 and DLCO as independent determinants of the best 6MWD (R2 = 0.58).
Conclusions: The 6MWT was considered to be reliable and valid in patients with asthma, which strengthens its clinical utility. However, the majority of patients demonstrated a considerable learning effect in the second 6MWT, providing a strong rationale for performing two 6MWTs.
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