Teste de 6 Minutos Em Amputados Transtibiais

8/12/2019 Teste de 6 Minutos Em Amputados Transtibiais

1/6

ORIGINAL ARTICLE

Six-Minute Walk Test in Persons With Transtibial Amputation

Suh-Jen Lin, PT, PhD, Nisha Hathi Bose, PT, MS

ABSTRACT. Lin S-J, Bose NH. Six-minute walk test in personswith transtibial amputation. Arch Phys Med Rehabil 2008;89:2354-9.

Objective: This study was to report the within-day test-retest reliability and the measurement properties of the six-minute walk test (6MWT) in persons with lower-limb (trans-tibial) amputation.

Design: Test-retest study design.Setting: University research laboratory.Participants: Subjects (N13) with transtibial amputation

(9 men and 4 women; mean age, 46y).Interventions: Three trials of the 6MWT were conducted

within 1 day with 20 to 30 minutes of rest between consecutivetrials. Timed Up & Go (TUG) test and timed one-leg balancetests were conducted on another day.

Main Outcome Measures: (1) Distance, heart rate, symp-toms and signs of exercise intolerance during the walk test, (2)

times of the TUG test and the one-leg balance test.Results:The intraclass correlation coefficient (ICC3,1) value

was .94. Bland and Altman graphs showed no systemic varia-tions between trials and a small learning effect. The peak heartrate approximated 72% to 78% of the age-predicted maximalheart rate. Moderate degrees of correlation were observed in:(1) the 6MWT versus the TUG test (r.76, P.05), and (2)the 6MWT versus the timed prosthetic-leg stance (with eyesopen: r.63, P.05; with eyes closed: r.61, P.05).

Conclusions: These findings suggest that the 6MWT couldbe considered as a reliable measure of functional capacity,involves a moderate degree of exercise intensity, and is relatedin a moderate degree to postural control abilities in personswith transtibial amputation.

Key Words: Amputees; Rehabilitation.

2008 by the American Congress of Rehabilitation Medi-cine and the American Academy of Physical Medicine and

Rehabilitation

THE REPORTED PREVALENCE offalling in community-dwelling amputees is about 52.4%,1 which is higher thanthat reported among the elderly; additionally, 62% of theseamputees are reported to have more than 2 common healthproblems.1 With a lower-limb amputation, a person tends tolive a sedentary lifestyle, possibly due to a fear of falling andthe increased energy expenditure associated with prosthetic

ambulation, particularly in the presence of multiple chronicdiseases. To design a fitness training program for amputees, areliable and feasible exercise test is important for quantifyingexercise capacity, identifying symptoms and signs of exerciseintolerance, and prescribing safe exercise programs in a com-munity setting.

Determination of exercise capacity in persons with lower-limbamputation has been a challenge. Different modes of exercisetesting have been reported,such as one-leg cycling,2,3 arm ergom-etry,4 arm-leg ergometry,5 and treadmill exercise.5 During reha-bilitation, arm ergometry might be a good choice due to weaknessof the amputated leg, yet increased cardiac demand is a concern.The combined arm and leg ergometer exercise could challengeanamputee to a higher capacity than that of the arm ergometer,5 butthe equipment is expensive. When able to walk independently inthe community with a prosthesis, an amputee has a better aerobiccapacity than those still in rehabilitation, but may not have theskillful balance to walk comfortably on a treadmill. Therefore, afield exercise test (eg, walk tests) might better reflect an amputeesexercise capacity in the community than the aforementioned tra-ditional exercise tests. Walk tests measure how far a person canwalk within a certain limit of time. They are related to day-to-dayactivities, are easy to administer, and yield valuable information.Originally, a 12-minute running test was reported as a reliablefield test of exercise capacity in healthy adults and it correlatedmodestly with a persons maximum oxygen consumption.6 Later,this test was modified to a walk test in patients with chronicobstructive pulmonary disease.7 The 12-minute test was time-consuming for clinicians, so 2- and 6- minute versions of walktests were evolved, and the 6MWT was shown to adequatelydifferentiate exercise capacities among subjects while saving

time.

8

Many factors affect the performance in walk tests, such asverbal encouragement,9 walkway layout and length,10 and thenumber of practice trials.11 With advances in technology, avariety of physiologic monitoring can be incorporated intowalk tests, such as pulse oximetry, metabolic analysis, andtelemetry electrocardiography. Not only could functional ca-pacity be quantified, but also the limiting factors of exerciseintolerance, such as arrhythmia, oxygen desaturation, and an-aerobic threshold could be identified.12-17

Initially, the 6MWT was primarily applied in patients withcardiac or respiratory diagnoses.11,18,19 Later, it was applied tothe elderly,17,20 to children,21 and to patients with renal fail-ure,22 fibromyalgia,23 and cerebral palsy.24 In the above stud-

From the School of Physical Therapy, Texas Womans University, (Lin) and theDepartment of Physical Medicine and Rehabilitation, Baylor University MedicalCenter, (Hathi), Dallas, TX.

Presented to the Texas Physical Therapy Association, October 2729, 2006, FtWorth, TX, and to the American Physical Therapy Association, February 1417,2007, Boston, MA.

Supported by the Texas Physical Therapy Foundation.No commercial party having a direct financial interest in the results of the research

supporting this article has or will confer a benefit on the authors or on any organi-zation with which the authors are associated.

Reprint requests to Suh-Jen Lin, PT, PhD, 8194 Walnut Hill Ln, Dallas, TX 75231,e-mail:[email protected].

Published online November 1, 2008 at www.archives-pmr.org.

0003-9993/08/8912-00039$34.00/0doi:10.1016/j.apmr.2008.05.021

List of Abbreviations

ANOVA analysis of variance

BMI body mass index

CI confidence interval

ICC intraclass correlation coefficient

LOA limit of agreement

LSD least significant difference

RPE rating of perceived exertion

6MWT six-minute walk test

TUG Timed Up & Go

2354

Arch Phys Med Rehabil Vol 89, December 2008
mailto:[email protected]://www.archives-pmr.org/http://www.archives-pmr.org/mailto:[email protected]://www.archives-pmr.org/


2/6

ies, the test-retest reliability values were high, with ICC valuesranging from .82 to .99, except for patients with fibromyalgia(ICC.73). Taking learning effect into consideration,1 prac-tice trial of the 6MWT is generally recommended.11 For thecriterion-related validity of the 6MWT, the distance ambulatedhas been consistently shown tocorrelatemoderately to a per-sons peak oxygen consumption.11,18,19,21

Besides aerobic capacity, other factors such as one-leg bal-ance and postural control might affect performance in walktests. Timed one-leg balance was shown to have moderate to highreliability in healthy adults and could predict falls in the elderly.25

Gait asymmetry and reduced prosthetic leg stance time are char-acteristics of amputee gait.26 A good one-leg balance shouldenable an amputee to walk a longer distance because walking is aseries of alternating cycles between the stance phase and the swingphase. The TUG test is another measure of physical mobility. Thetest involves asking a subject to stand up from an armchair, walk3m, turn, walk back to the chair, and sit down. The TUG test issimilar to many daily activities involving transfer, balance, walk-ing speed, and turning around. The TUG test was shown to havehigh intrarater and interrater reliability values,27 and good contentvalidity and concurrent validity with other balance measures andwalking speed.28 The postural control of turning around at the end

of 3-m walking seems to be similar to the turning around move-ment at the end of each lap of walking during walk tests. Hence,it is likely that an amputee with a better walking speed andefficiency in turning around during the TUG test could also walka longer distance in the 6MWT.

The distance of the 6MWT reflects whether a person couldpractically ambulate in the community. The requirements oftypical community ambulation such as walking in a supermar-ket or a department store involve a distance of about 132m to342m for communities of different sizes.29 Previously, the2-minute walk test in amputees showed goodreliability, wascapable of predicting rehabilitation potential,30 and correlatedwell to other physical functions.31 However, the distance cov-ered in 2 minutes is too short compared with typical commu-nity ambulation.

In this study, we explored the within-day test-retest reliabil-ity and other measurement properties of the 6MWT in personswith lower-limb amputations. We hypothesized that the firsttrial would be as reliable as the second and the third trials (ie,there will be good agreement among the 3 trials of the 6MWT).Secondly, we quantified the exercise intensity and describedpossible symptoms and signs of exercise intolerance associatedwith the 6MWT in amputees, such as shortness of breath, chestpain, fatigue, leg claudication, oxygen desaturation, or arrhyth-mia. Thirdly, we examined its clinical measurement propertiesby correlating the distance of walking in the 6MWT to 2postural control measures: the TUG test and the timed one-legbalance test at eyes-open and eyes-closed conditions. We hy-pothesized that subjects who had a better postural control,indicated by a longer one-leg balance time and a quicker

(shorter time in the) TUG test, would walk a longer distance inthe 6MWT.

METHODS

Subjects

Thirteen subjects (9 men and 4 women; 1 Hispanic, 1 black,and 11 whites) with unilateral below-knee (transtibial) ampu-tation participated in this study. Subjects were recruitedthrough local advertisement as well as a support group forpeople with amputations. The causes of amputation includedtrauma (in 9 subjects) and vascular problems (in 4 subjects).The inclusion criteria included the following: with transtibial

amputation, walking independently with a prosthesis in thecommunity, absence of skin breakdown of the residual limb inthe past 3 months, and having well-controlled medical condi-tions. All prospective subjects who fulfilled the inclusion cri-teria were recruited as subjects. In addition, participants inpreviously mentioned studies of the 6MWT walked indepen-dently; therefore, we chose to use similar criteria and to ex-clude those amputees who used assistive devices, had recentillness, or had hospital admissions. Informed consent was ob-tained. The experimental protocol was approved by the Insti-tutional Review Board of the Texas Womans University.

Study Protocol

Two test sessions were conducted. The first session con-sisted of informed consent, basic data collection, and 3 trials ofthe 6MWT. The second session scheduled within 2 weeks ofthe first session was for the TUG test and the timed one-legbalance test. In order to minimize the drop-out rate and toreduce the number of testing sessions, we conducted the 3 trialsof 6MWT within 1 day, but provided participants with 20 to 30minutes of rest between trials to minimize the influence offatigue.

Procedure

Basic data included medical history, age,height, weight, andthe amputee Day activity questionnaire.32 The Day activityquestionnaire is a brief scoring form which evaluates an am-putees ability in the following categories: putting on andtaking off the prosthesis, the length of time using the prosthe-sis, stairs climbing, details of employment, ambulation aidsused, domestic responsibilities, regular walking habits, andsocial activities. Based on the assessment of clinical records ofthe amputee participants by experienced clinicians, the activitylevels of participants were classified into 5 categories. It wasfound that the 5 activity levels corresponded to specific rangesof the Day activity scores (very high, 30; high, 1029;average, 9 to 9; restricted, 40 to 10; inactive, 40). In

addition, the activityscore was shown to correlate linearly toannual step counts.32

Six-minute walk test. The6MWT was conducted accord-ing to published standards.11 Heart rhythms were monitoredcontinuously with a modified chest lead V5by the ECG telem-etry system.a Blood pressure, oxygen saturation through a pulseoximeter,b and RPE of the 10-point Borg scale33 were recordedprior to and immediately at the completion of each trial. Sub-

jects had at least 20 minutes of rest between consecutive trialsto allow the heart rate to return to baseline. Prior to each trial,subjects were instructed to walk in an extended stretch (45.72mor 150ft) of hallway with cones marking the distance accordingto the following standardized written instructions:

The object of this test is to walk as far as possible for 6minutes. You are to walk back and forth in this corridor.

Six minutes is a long time to walk, so you will be exertingyourself. You will probably get out of breath or becomeexhausted. You can speed up, slow down, or take a rest.You may lean against the wall whileresting, but resumewalking as soon as you are able . . .11

To partially account for a possible memory effect, eachsubject began the 3 trials at 3 different starting points along thepath. Standardized words of encouragement were called out toeach subject at each minute mark (Keep up the good work,you have x minutes left!). One investigator provided theencouragement, monitored the signs and symptoms of exerciseintolerance when a subject passed by, and recorded the numberof laps walked.

2355SIX-MINUTE WALK TEST IN PERSONS WITH TRANSTIBIAL AMPUTATION, Lin



3/6

Timed Up & Go test. Each subject was instructed to risefrom a standard armchair, walk a 3-m short distance, turnaround, walk back, and return to sit in the chair according to theoriginal guideline.28 The time to complete the TUG test wasrecorded, and the average of 3 trials was used for data analysis.

Timed one-leg balance test. We demonstrated the proce-dures to subjects first. Initially, each subject stood on both legswith eyes open. Then, one researcher counted down backwardfrom 3 seconds to 1 second, and called out go, and the subjectwas expected to maintain one-leg balance on one leg whileraising the other leg. The test was terminated when either thenonsupporting leg touched the ground or the subject main-tained the balance for 30 seconds25 (the ceiling of the test).Subjects started with the sound leg, then the amputated leg.

After 3 trials on each leg, they repeated the procedures witheyes closed. One research assistant stood in front of the subjecttiming the test, and another assistant stood behind the subjectfor protection from falls. The variability of the 3 trials for eachcondition was analyzed and the average of the 3 trials for eachcondition was used for final data analysis.

Data Analysis

Data were analyzed using SPSS version 12.0.c Descriptivestatistics were used for basic data analysis. The relative reli-ability among the 3 trials was analyzed with the ICC (model 3)because this model is appropriate for test-retest reliability. Wealso used the Bland-Altman graphs with limits of agreement toexpress the actual units of measurement, as well as the pairedt test with a 95% CI to assess whether there was a systemic

change in the mean (absolute reliability).A separate 1-way repeated measures ANOVA was con-ducted to test for differences on peak heart rate and meanarterial blood pressure. If significant effect existed, the post hocFishers LSD pairwise comparison was conducted. The Fried-man 1-way repeated measures ANOVA by ranks was used forthe RPE scale for the 3 trials. Fishers LSD pairwise compar-isons were calculated for significant effects.

Reliability of the 3 trials of the timed one-leg balance testwas examined with ICC3,1. The Pearson correlation analysiswas used to analyze the relationships between the distanceambulated and: the mean time of the TUG test, and the meantimes of the timed one-leg balance test on the prosthetic leg and

on the sound leg under eyes-open and eyes-closed conditions.The level of significance () was set at .05.

RESULTS

The subject characteristics were as follows: age, 46.014.8years; height, 174.310.8cm; weight, 85.918.6kg; BMI,28.03.6kg/m2. The average number of years of prosthesisexperience was 7.619.25, ranging from 6 months to 32 yearsfor the 4 vascular amputees and from 3 months to 18 years forthe 9 traumatic amputees. Four traumatic amputees did nothave any medical comorbidities: 3 had used prosthesis for 1month to 1.5 years, and 1 who had amputation in childhood hadused prosthesis for over 15 years. Nine of the 13 amputees hadmultiple cardiovascular comorbidities, where 8 had hyperten-sion, 7 were overweight (BMI, 2529.9 kg/m2), 6 had meta-bolic syndrome, 5 reported high cholesterol, 4 were class Iobese (BMI, 30 34.5kg/m2), 3 had arrhythmia, 3 had diabetes,2 had peripheral vascular disease, and 1 had undergone coro-nary artery bypass. Nine of 13 subjects had more than 2common health problems. The average Day activity score was3111. The subjects were either part-time employed or full-time homemakers, except for 1 subject who was temporarilyunemployed.

The ICC for the 3 trials of the 6MWT was .94. Figure 1shows the Bland-Altman graph on the difference of distanceambulated between trials 2 and 1 (trial 2 minus trial 1) plottedagainst their means for each subject, with 95% CI and 95%LOA. There are no systemic errors and no statistically signif-icant difference between trial 2 and trial 1 (zero was includedin the 95% CI). Infigure 2,the Bland-Altman graph also showsno systemic variation but with a significant difference betweentrial 3 and trial 2 (zero was not included in the 95% CI).

All 13 subjects completed the 3 trials without the need of restduring the 6MWT. One subject had occasional abnormal heartrhythm of premature ventricular contraction at rest, but nofurther abnormal rhythms were observed during the test and noother abnormal symptoms or signs of exercise intolerance wereelicited. No subjects experienced intermittent claudication,

chest pain, or oxygen desaturation. Three subjects with hyper-tension had a higher blood pressure response (up to 180mmHg), but it did not reach the level required for terminationof the walk test.

The detailed results of peak heart rate, mean arterial bloodpressure, RPE, and distance of the 6MWT are shown intable 1.

Bland-Altman Plot

70

60

50

40

30

2010

0

10

20

30

40

50

60

70

400 450 500 550 600 650 700 750

Average of Trial 1 and Trial 2 (meter)

Differenceo

fTrial2T

rial1

LOA 63.5

LOA 44.6

9.45 mean

95%CI

95%CI

Fig 1. Bland-Altman graph with LOA. The differences between trial2 and 1 (trial 2 minus trial 1) plotted against their mean for eachsubject, together with the 95% CI and the 95% LOA.

Bland-Altman Plot

50

40

30

20

10

0

1020

30

40

50

60

70

80

400 450 500 550 600 650 700 750

Average of Trial 2 and 3 (meter)

DifferenceofTrial3T

rial2

LOA

57.8

mean

LOA

25.8

16

95% CI

95% CI

Fig 2. Bland-Altman graph with LOA. The differences between trial3 and 2 (trial 3 minus trial 2) plotted against their mean for eachsubject, together with the 95% CI and the 95% LOA.

2356 SIX-MINUTE WALK TEST IN PERSONS WITH TRANSTIBIAL AMPUTATION, Lin



4/6

Results showed a significant main effect for peak heart rate(F2,245.96, P.02). Results of mean arterial blood pressuredid not show a significant main effect (F2,24.23, P.74),indicating that mean arterial pressure did not significantlychange among the 3 trials. Results of RPE also did not show asignificant main effect (F2,242.04, P.16), indicating thatRPE did not significantly change among the 3 trials.

Twelve subjects performed the TUG test and the timedone-leg balance test. One man dropped out for the second testsession. The relationship between the walk test and the TUGtest was shown in figure 3(P.004). The reliability of the 3trials of the timed one-leg balance test washigh, except for the2 conditions of the prosthetic leg (table 2). There were mod-erate correlations between the distance ambulated and the timesof the mean timed one-leg balance on the prosthetic leg ateyes-open and eyes-closed conditions (r.63 and r.61,P.05, respectively). The correlation coefficients between the

distance ambulated and the times of the timed one-leg balancetest on the sound leg were low (eyes open, r.00; eyes closed,r.42).

DISCUSSION

The prevalence of cardiovascular comorbidity in our sub-jects was alarming. This prevalence was close to that reportedfor community-dwelling amputees (62%).1 Five of the 9 trau-matic amputee subjects seemed to have developed multiplecardiovascular comorbidities over the years, which was possi-bly due to physical inactivity. One limitation of our study isthat we had a mixed group of amputees. It could not bedetermined whether the comorbidities in vascular amputeeswere due simply to a sedentary lifestyle or to a combination ofvascular problems and sedentary lifestyle. Although our sub-

jects average activity level was classified as high based on theamputee Day activity questionnaire,32 it only reflected that theycould carry out daily activities most of the time and did notindicate that they actively participated in regular exercises. Thehigh prevalence of comorbidity reflected the urgent need ofsecondary prevention in persons with lower-limb amputation.

With the standardized protocol, the learning effect of the6MWT was likely minimized. The high ICC value for thedistance of walking among the 3 trials indicated excellenttest-retest reliability, which was close to those reported in theliterature.11,18,19 Although we found a statistically significantlearning effect from trial 2 to trial 3, the difference of 16m wassmall when compared with the suggested clinically significant

distance of improvement for the 6MWT after interventions (ie,5480m).11,18,34 Based on the high ICC value and the absenceof systemic errors from trial to trial, we consider that the6MWT has a good within-day test-retest reliability of func-tional capacity in persons with lower-limb amputation, but 2practice trials are recommended. However, whether the 6MWTis sensitive to change after exercise training in this populationwould await further studies.

Although there were no systemic variations in the distance ofwalking, we observed 2 outliers on the Bland-Altman graphs.One subject walked a much shorter distance on the second trial.Because similar rest periods between trials were provided to allsubjects, and this subjects third trial was actually close to hisfirst trial, it was unclear whether it was due to fatigue. Furtherstudies involving between-day tests could help elucidate thepossible role of fatigue. Another subject walked a much longerdistance on the third trial. We speculate that this subject mighthave perceived the third trial as his last trial, and thus wantedto do his best. Future studies incorporating feedback fromparticipants on how they accomplished those distances in the6MWT, on whether they used their usual speed or tried theirbest for each trial, might provide us with more insights on thisissue.

The peak heart rate responses seemed to have a differenttrend. Our amputee subjects might have worked harder for trial2 and trial 3. However, neither the mean arterial pressure northe RPE scale was significantly different. Because we haveonly examined the within-day reliability of the 6MWT, furtherstudies involving the 6MWT on different days might rule outthe possible effects of any cumulative physiologic effects.Incorporation of metabolic analysis during the 6MWT mightyield more objective information on exercise capacity thanwhat was available with the measurement of heart rate alone,because factors other than exercise could affect the heart rateresponse.

Our subjects appeared to have achieved their best perfor-mance. As shown in table 1, their average walking speedsranged from 1.51 to 1.58m/s (3.43.6mph), which were faster

than the common comfortable walking speedsof healthy adultsaged 20 to 60 years (1.29m/s to 1.46m/s).35 In addition, theirrelative exercise intensities were about 72% to 78% of theirage-predicted maximal heart rates, which were slightly lowerthan those reported in the literature (about 78%85% of the

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

300 350 400 450 500 550 600 650 700

Distance of Trial 1 (meter)

TimedUpand

GoTest(sec)

r= 0.76

Fig 3. Relationship between the distance of walking and time of theTUG test.

Table 1: Results of the 3 Trials of the 6MWT

Categories

Trial 1 Trial 2 Trial 3

Mean SD Mean SD Mean SD

Distance (m) 544.664.5 554.071.4 570.080.1

Average speed (m/s) 1.510.18 1.540.20 1.580.22

Peak heart rate (%

age-predicted

maximal*) 72.27.0 76.48.0 77.810.0

Mean arterial pressure(mmHg) 110.010.0 109.08.0 109.08.0

RPE 3.51.6 3.51.5 4.02.2

*(Peak heart rate/[220 age]) 100%.(Diastolic pressure 1/3 [systolic pressure diastolic pressure]).Pairedttest showed significant differences between trial 3 and trial1, and between trial 3 and trial 2 (P.05).1-way repeated measures ANOVA (P.05). Pairwise comparisonsshowed significant differences between trial 1 and trial 2, and be-tween trial 1 and trial 3 (P.05).




5/6

peak heart rate).12,13,15-17 A few of our subjects took betablockers, which could blunt heart rate response. Some subjectshad multiple cardiovascular comorbidities. These factors limitthe accuracy of predicting maximal heart rate from the age-predicted equation. Hence, we could have overestimated theirmaximal heart rate.

On the relationships with clinical measurement properties,

the 6MWT seems to examine similar aspects of postural con-trol as the TUG test. With a small sample size, we observed amoderately negative linear relationship between the distancewalked and the time of the TUG testthe better the perfor-mance in the TUG test (ie, quicker, shorter time), the greaterthe distance an amputee can walk in the 6MWT. Our TUG testresults were close to those of elderly people in their sixties.36

Previously, the 2-minute walk test in amputees also showed anegative correlation between the distance ambulated and thetime of the L-Test (a modified version of TUG test),31 but itwas in a curvilinear fashion. That was probably due to theceiling effect of the 2-minute walk test, which was not ob-served in this study.

Furthermore, the loss of voluntary ankle control after trans-tibial amputation has likely contributed to the impaired pros-

thetic-leg balance and the shorter distance of walking, asshown by the moderately positive correlations between theprosthetic-leg balance and the distance ambulated. Addition-ally, the redundancy of postural control from visual and pro-prioceptive inputs also seemed to have been reduced for thesound leg. These findings point to the need to incorporatebalance training into traditional fitness programs for personswith lower-limb amputation. An improved balance could po-tentially reduce the fear of falling and increase participation inphysical activities. This hypothesis would require further stud-ies.

CONCLUSIONS

Overall, the current study suggests that the 6MWT can beconsidered as a reliable and practical exercise test to be used inhealth promotion programs for community-dwelling amputees,because it showed excellent within-day test-retest reliabilityand seemed to adequately challenge an amputees functionalcapacity, balance, and postural control abilities, as required incommunity ambulation. However, the findings of this studyshould be substantiated by further studies with a larger samplesize and between-day trials.

Acknowledgments: We thank Lori Hall, PT, MS, for her assis-tance in funding procurement at the initial stage of the project, and thefollowing physical therapists for their assistance in data collection anddata analysis: Erin George, MS, Jeff Hogan, MS, Paul Walters, MS,Cassie Sommerlad, MS, Tracy Dingman, MS, and Lola Elder, MS.

References1. Miller WC, Speechley M, Deathe B. The prevalence and risk

factors of falling and fear of falling among lower extremity

amputees. Arch Phys Med Rehabil 2001;82:1031.

2. Chin T, Sawamura S, Fujita H, et al. The efficacy of the one-leg

cycling test for determining the anaerobic threshold (AT) of lower

limb amputees. Prosthet Orthot Int 1997;21:141-6.

3. Chin T, Sawamura S, Fujita H, et al. Physical fitness of lower limbamputees. Am J Phys Med Rehabil 2002;81:321-5.

4. Davidoff G, Lampman R, Westbury L, Deron J, Finestone H,

Islam S. Exercise testing and training of persons with dysvascular

amputation: safety and efficacy of arm ergometry. Arch Phys Med

Rehabil 1992;73:334-8.

5. Fletcher G, Lloyd A, Waling J, Fletcher B. Exercise testing in

patients with musculoskeletal handicaps. Arch Phys Med Rehabil

1988;69:123-7.

6. Cooper KH. A means of assessing maximal oxygen intake: correla-

tion between field and treadmill testing. JAMA 1968;203:201-4.

7. McGavin C, Gupta S, McHardy G. Twelve-minute walking test

for assessing disability in chronic bronchitis. BMJ 1976;1:822-3.

8. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-,

six-, and 12-minute walking tests in respiratory disease. BMJ1982;284:1607-8.

9. Guyatt GH, Pugsley SO, Sullivan MJ, et al. Effect of encourage-

ment on walking test performance. Thorax 1984;39:818-22.

10. Sciurba F, Criner GJ, Lee SM, et al. Six-minute walk distance in

chronic obstructive pulmonary disease: reproducibility and effect

of walking course layout and length. Am J Respir Crit Care Med

2003;167:1522-7.

11. American Thoracic Society. ATS statement: guidelines for the

six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7.

12. Turner SE, Eastwood PR, Cecins NM, Hillman DR, Jenkins SC.

Physiologic responses to incremental and self-paced exercise in

COPD: a comparison of three tests. Chest 2004;126:766-73.13. Peel C, Ballard D. Reproducibility of the 6-minute walk test in

older women. J Aging Phys Act 2001;9:184-93.14. Deboeck G, Niset G, Vachiery JL, Moraine JJ, Naeije R. Physi-

ological response to the six-minute walk test in pulmonary arterialhypertension. Eur Respir J 2005;26:667-72.

15. Paap E, van der Net J, Helders PJ, Takken T. Physiologic responseof the six-minute walk test in children with juvenile idiopathicarthritis. Arthritis Rheum 2005;53:351-6.

16. Troosters T, Vilaro J, Rabinovich R, et al. Physiological responsesto the 6-min walk test in patients with chronic obstructive pulmo-nary disease. Eur Respir J 2002;20:564-9.

17. Kervio G, Carre F, Ville NS. Reliability and intensity of thesix-minute walk test in healthy elderly subjects. Med Sci SportsExerc 2003;35:169-74.

Table 2: Three Trials of the Timed One-Leg Balance at Eyes-Open and Eyes-Closed Conditions and the Corresponding ICC

Groups Trial Sound Leg (s) ICC3,1 Prosthetic Leg (s) ICC3,1

Eyes open (n12)

1 24.5210.66 0.93 1.430.77 0.40

2 23.6011.61 2.311.25

3 26.199.01 3.002.29

Mean 24.779.82 2.261.06

Eyes closed (n12)

1 8.478.63 0.70 0.990.52 0.482 10.0710.13 1.180.40

3 9.4210.09 1.130.62

Mean 9.330.42 1.100.37

NOTE. Values are mean SD unless otherwise noted.

2358 SIX-MINUTE WALK TEST IN PERSONS WITH TRANSTIBIAL AMPUTATION, Lin



6/6

18. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic

overview of the measurement properties of functional walk tests used

in the cardiorespiratory domain. Chest 2001;119:256-70.

19. Sadaria KS, Bohannon RW. The 6-minute walk test: a brief

review of literature. Clin Exerc Physiol 2001;3:127-32.

20. Harada ND, Chiu V, Stewart AL. Mobility-related function in

older adults: assessment with a 6-minute walk test. Arch Phys

Med Rehabil 1999;80:837-41.

21. Li AM, Yin J, Yu CC, et al. The six-minute walk test in healthychildren: reliability and validity. Eur Respir J 2005;25:1057-60.

22. Fitts SS, Guthrie MR. Six-minute walk by people with chronicrenal failure. Assessment of effort by perceived exertion. Am JPhys Med Rehabil 1995;74:54-8.

23. King S, Wessel J, Bhambhani Y, Maikala R, Sholter D, Maksy-mowych W. Validity and reliability of the 6 minute walk inpersons with fibromyalgia. J Rheumatol 1999;26:2233-7.

24. Andersson C, Asztalos L, Mattsson E. Six-minute walk test inadults with cerebral palsy. A study of reliability. Clin Rehabil2006;20:488-95.

25. Bohannon RW. One-leg balance test times. Percept Mot Skills1994;78:801-2.

26. Sanderson D, Martin P. Lower extremity kinematic and kineticadaptations in unilateral below-knee amputees during walking.

Gait Posture 1997;6:126-36.27. Schoppen T, Boonstra A, Groothoff JW, de Vries J, Geken LN,

Eisma WH. The timed up and go test: reliability and validity inpersons with unilateral lower limb amputation. Arch Phys MedRehabil 1999;80:825-8.

28. Podsiadlo D, Richardson S. The timed Up & Go: a test of basicfunctional mobility for frail elderly persons. J Am Geriatr Soc1991;39:142-8.

29. Robinett CS, Vondran MA. Functional ambulation velocity anddistance requirements in rural and urban communities. A clinicalreport. Phys Ther 1988;68:1371.

30. Brooks D, Hunter JP, Parsons J, Livsey E, Quirt J, Devlin M.Reliability of the two-minute walk test in individuals withtranstibial amputation. Arch Phys Med Rehabil 2002;83:1562-5.

31. Deathe A, Miller W. The L test of functional mobility: measure-ment properties of a modified version of the timed up & go test

designed for people with lower-limb amputations. Phys Ther2005;85:626-35.

32. Day H. The assessment and description of amputee activity.Prosthet Orthot Int 1981;5:23-8.

33. Borg GA. Psychophysical bases of perceived exertion. Med SciSports Exerc 1982;14:377-81.

34. Wise RA, Brown CD. Minimal clinically important differences inthe six-minute walk test and the incremental shuttle walking test.COPD 2004;2:125-9.

35. Bohannon RW. Comfortable and maximum walking speed ofadults aged 2079 years: reference values and determinants. AgeAgeing 1997;26:15-9.

36. Steffen TM, Hacker TA, Mollinger L. Age- and gender-relatedtest performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, andgait speeds. Phys Ther 2002;82:128-37.

Suppliersa. Life Sensing Instrument Co, 329 W Lincoln St, Tullahoma, TN

37388.b. Smiths Medical PM Inc, N7W22025 Johnson Dr, Waukesha, WI

53186.c. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.



Teste de 6 Minutos Em Amputados Transtibiais

Documents

Transcript of Teste de 6 Minutos Em Amputados Transtibiais