Tool Description

  • A self-paced test. It measures the distance that a patient can walk on a flat, hard surface in 6 minutes.
  • assesses the sub-maximal level of functional capacity.
  • The test in its entirety evaluates the integrated response of pulmonary, cardiovascular, and circulatory systems, in addition to level of motor control, functional neuromuscular units, and muscle.
  • The 6MWT is widely used in many populations and primarily in incomplete SCI.

ICF Domain

Activity ▶ Mobility

Administration

  • clinician-administered
  • may be performed either indoors or outdoors, along a long, flat, straight, and hard surface
  • 6 minutes is required for the actual test
  • 5-10 minutes is required to set up and explain the test to the patient
  • the American Thoracic Society (ATS) recommends that the walking course should be:
    •  30 meters in length
    • marked at every 3 meters
    • marked with a cone at turn-around points

Equipment required

  • countdown timer
  • tape measure
  • mechanical lap counter
  • cones to mark the turnaround
  • chair that can be easily moved along the walking course.

Because the test was originally developed for stroke patients, the American Thoracic Society also recommends that a source of oxygen, sphygmomanometer, telephone, and an automated electronic defibrillator be available.

Scoring

  • Total distance walked (rounding to the nearest meter) and the number and duration of rests during the test is reported.
  • Physiological measures such as dyspnea and fatigue level can be measured using the Borg Scale and pulse oximetry (baseline heart rate and oxygen saturation) can also be recorded at the beginning and end of the test.

Clinical Considerations

  • According to the American Thoracic Society, the 6MWT is easier to administer, better tolerated, and more reflective of activities of daily living than other walking tests.
  • There are many sources of variability including height, age, body weight, sex, and motivation.
  • The participant uses their typical walking aid during the test.
  • Other versions of the test such as the 2 Minute Walk Test and the 10 Meter Walk Test can be administered as part of the 6 MWT.

Availability

Can be found here.

No administration cost. For additional protocol details, refer to ATS Statement: Guidelines for the Six-Minute Walk Test. Test instructions are available (Function ATSCoPSfCP. ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine. 2002; 166(1):111-7.)

Interpretability

MCID: 0.10 m/s (Forrest et al. 2014)

SEM: 16.5 metres (Lam et al. 2008 – calculated from measurements made in van Hedel et al. 2005)
MDC: 45.8 metres (Lam et al. 2008– calculated from measurements made in van Hedel et al. 2005)

Standard Error of Measurement:
12.3 m; 0.0342 m/s
(Musselman and Yang 2013; n=20; 14 males, 6 females; incomplete SCI; and mean (SD) time since injury: 5.4 (8.8) years)

Minimal Detectable Change:
0.086 m/s
(Tester et al. 2016; n=72, 57 males, 15 females; 17 ASIA A, 10 ASIA B, 20 ASIA C, and 25 ASIA D; 44 cervical, 28 thoracic; and median (range) time since SCI: 0.7 (0.1-14.7) years)

37.1 m; 0.103 m/s
(Duffell et al. 2015; n=83; 57 males, 26 females; incomplete SCI; and >12 months post-injury)

  • Normative data and published data is available for comparison for the SCI population (see the Interpretability section of the Study Details sheet).
  • Scores range from 0 meters or feet for patients who are non-ambulatory to the maximum biological limits for normal healthy individuals (approximately 900 meters or 2953 feet).

Languages

N/A

Training Required

None

Measurement Property Summary

# of studies reporting psychometric properties: 15

Reliability

  • Intra-rater reliability is High (r=0.981-0.99)
  • Inter-rater reliability is High (r=0.970-1.00).

(Van Hedel et al. 2005, Scivoletto et al. 2011)

Validity

  • Correlation at 3 months post injury is high with:
    • 50 foot walking speed (r=0.95)
    • Walking Index for Spinal Cord Injury (WISCI I) (r=0.76)
    • Timed Up and Go (Spearman ρ =0.88)
  • Correlation at 3 months post injury is Moderate with:
    • the Berg Balance Scale (Spearman ρ =0.48)
    • Lower Extremity Motor Score (r=0.34)
    • WISCI II (Spearman ρ =0.60).

(Van Hedel et al. 2005, Van Hedel et al. 2006, Ditunno et al. 2007, Datta et al. 2009)

Responsiveness

  • The 6MWT differed between 1 month and 3 months (mean score increased from 314 to 473 metres, P<.001) and between 3 months and 6 months (mean score increased from 473 to 502 metres, P=.01) but not between 6 months and 12 months (mean score decreased from 502 to 495 metres, P=.76)

(van Hedel et al., 2006)

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the 6MWT for the SCI population.

Reviewers

Dr. Janice Eng, John Zhu, Jeremy Mak, Kyle Diab, Joanne Chi

Date Last Updated

July. 20, 2019

Amatachaya S, Naewla S, Srisim K, Arrayawichanon P, Siritaratiwat W. Concurrent validity of the 10-meter walk test as compared with the 6-minute walk test in patients with spinal cord injury at various levels of ability. Spinal Cord. 2014;52(4):333-6.
http://www.ncbi.nlm.nih.gov/pubmed/24445972

American Thoracic Society. ATS Statement: Guideline for the Six-Minute Walk Test. Am J Respir Crit Care Med 2002; 166: 111-117.
http://www.ncbi.nlm.nih.gov/pubmed/12091180

Barbeau H, Elashoff R, Deforge D, Ditunno J, Saulino M, Dobkin BH. Comparison of speeds used for the 15.2-meter and 6-minute walks over the year after an incomplete spinal cord injury: the SCILT Trial. Neurorehabil Neural Repair. 2007;21(4):302-6.
http://www.ncbi.nlm.nih.gov/pubmed/17369517

Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries. Arch Phys Med Rehabil 2009;90:1208-17.
http://www.ncbi.nlm.nih.gov/pubmed/19577035

Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550.
http://www.ncbi.nlm.nih.gov/pubmed/17507642

Duffell LD, Brown GL, Mirbagheri MM. Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury: Distinctions Revealed by Different Analytical Methods. Neurorehabil Neural Repair. 2015;29(6):566-76.
http://www.ncbi.nlm.nih.gov/pubmed/25398727

Enright, P.L. The Six-Minute Walk Test. Respir Care 2003;48(8):783–785.
http://www.ncbi.nlm.nih.gov/pubmed/12890299

Forrest GF, Hutchinson K, Lorenz DJ, et al. Are the 10 meter and 6 minute walk tests redundant in patients with spinal cord injury?. PLoS ONE. 2014;9(5):e94108.
http://www.ncbi.nlm.nih.gov/pubmed/24788068

Harkema SJ, Shogren C, Ardolino E, Lorenz DJ. Assessment of functional improvement without compensation for human spinal cord injury: extending the Neuromuscular Recovery Scale to the upper extremities. J Neurotraum 2016. Ahead of print. doi:10.1089/neu.2015.4213.
http://online.liebertpub.com/doi/10.1089/neu.2015.4213

Jackson AB, Carnel CT, Ditunno JF, et al. Outcome measures for gait and ambulation in the spinal cord injury population. J Spinal Cord Med. 2008;31(5):487-99.
http://www.ncbi.nlm.nih.gov/pubmed/19086706

Lam T, Noonan V, Eng JJ, SCIRE Research Team. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord, 2008; 46, 246-254.
http://www.ncbi.nlm.nih.gov/pubmed/17923844

Musselman KE, Yang JF. Spinal Cord Injury Functional Ambulation Profile: a preliminary look at responsiveness. Phys Ther. 2014;94(2):240-50.
http://www.ncbi.nlm.nih.gov/pubmed/24114437

Olmos LE, Freixes O, Gatti MA, Cozzo DA, Fernandez SA, Vila CJ, Agrati PE, Rubel IF. Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury. Spinal Cord, 2008; 46, 331-334.
http://www.ncbi.nlm.nih.gov/pubmed/17923845

Pithon KR, Abreu DC, Vasconcelos-neto R, Martins LE, Cliquet-jr A. Artificial gait in complete spinal cord injured subjects: how to assess clinical performance. Arq Neuropsiquiatr. 2015;73(2):111-4.
http://www.ncbi.nlm.nih.gov/pubmed/25742579

Scivoletto G, Tamburella F, Laurenza L, Foti C, Ditunno JF, Molinari M. Validity and reliability of the 10-m walk test and the 6-min walk test in spinal cord injury patients. Spinal Cord (2011) 49, 736–740; doi:10.1038/sc.2010.180;
http://www.ncbi.nlm.nih.gov/pubmed/21221120

Tester NJ, Lorenz DJ, Suter SP, et al. Responsiveness of the Neuromuscular Recovery Scale During Outpatient Activity-Dependent Rehabilitation for Spinal Cord Injury. Neurorehabil Neural Repair. 2016;30(6):528-38.
http://www.ncbi.nlm.nih.gov/pubmed/26359344

van Hedel HJA, Wirz M, Curt A. Improving walking assessment in subjects with incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-356.
http://www.ncbi.nlm.nih.gov/pubmed/16304565

van Hedel HJA, Wirz M, Dietz V. Assessing Walking Ability in Subjects with Spinal Cord Injury: Validity and Reliability of 3 Walking Tests. Arch Phys Med Rehabil 2005;86: 190-6.
http://www.ncbi.nlm.nih.gov/pubmed/15706542

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