Impact of Course Configuration on 6-Minute Walk Test Performance of People with Lower Extremity Amputations.

Purpose: The configuration of the 6-minute walk test (6MWT) may influence the distance walked and comparability of results among subjects and across programmes. The purpose of this study was to evaluate the relative and absolute test-retest reliability of two 6MWT configurations and to evaluate the agreement between these two configurations in users of lower extremity prosthetics. Methods: A cross-sectional design was used to analyze data from 25 subjects completing in-patient prosthetic rehabilitation (mean age 63.12 [SD 13.77] y; 72% male). Two configurations of the 6MWT were examined, and relative and absolute test-retest reliabilities were calculated. Bland-Altman plots were constructed to evaluate agreement between configurations. Results: The relative test-retest reliability was excellent for both Configuration 1 and Configuration 2: ICC 0.97, 95% CI: 0.93, 0.98, and ICC 0.97, 95% CI: 0.94, 0.99, respectively. Comparable values for absolute test-retest reliability were also found. The Bland-Altman plot demonstrated a difference of ±63.92 meters between configurations. Conclusions: The two 6MWT configurations had excellent relative and absolute test-retest reliability, but the results from each configuration do not agree sufficiently to make them interchangeable or directly comparable. This highlights the importance of explicitly indicating the test configuration for the 6MWT when reporting results.

Objectif : la configuration du test de marche de 6 minutes (TM6M) peut influencer la distance marchée et la comparabilité des résultats entre sujets et entre programmes. L'objectif de cette étude était d'évaluer la fiabilité relative et absolue test­retest de deux configurations de TM6M et d'évaluer la concordance de ces deux configurations chez des personnes portant une prothèse à un membre inférieur. Méthodologie : les chercheurs ont analysé les données de 25 sujets suivant une réadaptation prothétique à l'hôpital à l'aide d'une méthodologie transversale (âge moyen de 63,12 [ÉT 13,77] ans; 72 % d'hommes). Ils ont examiné les deux configurations du TM6M et calculé la fiabilité relative et absolue test­retest. Ils ont créé un graphique Bland­Altman pour évaluer la concordance entre les configurations. Résultats : la fiabilité relative test­retest était excellente pour les deux configurations. CIC 0,97; IC à 95 % (0,93; 0,98) et CIC 0,97; IC à 95 % (0,94; 0,99), respectivement. Ils ont aussi observé des valeurs comparables pour la fiabilité absolue test­retest. Le graphique Bland­Altman a révélé une différence de±63,92 m entre les deux configurations. Conclusions : les deux configurations du TM6M ont obtenu une excellente fiabilité relative et absolue test­retest. Cependant, les résultats de chaque configuration ne concordent pas suffisamment pour les rendre interchangeables ou directement comparables. Cette constatation fait ressortir l'importance d'indiquer explicitement la configuration du test pour le TM6M au moment de rendre compte des résultats.

Barriers to outcome measure administration and completion at discharge from inpatient rehabilitation of people with amputation.

We performed a retrospective chart review of consecutive patients discharged from an inpatient amputee rehabilitation program over a 2 yr period (January 2010-December 2011). Our objective was to determine barriers to the completion of a standardized maximum walk test (MWT) at discharge. Over the study period, there were 190 discharges. The sample had a mean age of 63.5 yr (standard deviation [SD] +/- 14.2 yr), was 71.6% male, and had a majority of transtibial amputation (67%). The average length of inpatient stay was 28.1 d (SD +/- 13.2 d). MWT including distance and time was completed in 149 (78%) of the discharges; the main factors limiting patient performance on this measure were cardiorespiratory fatigue (53%), lower-limb pain (24%), back pain (12%), and skin problems (6%). Among those patients who completed the MWT, in 31% no limiting factor was identified. Forty-one discharge MWTs were not completed as a result of nonambulatory status (34%), acute illness (17%), limb pain (7%), skin problems (12%), or other reasons. Knowing these limitations may direct care from a clinical standpoint and provides valuable data for research planning to further examine outcome measures in this population.