Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease.
OBJECTIVE
To establish the minimal important difference (MID) for the six-minute walk distance (6MWD) in persons with chronic obstructive pulmonary disease (COPD).


METHODS
Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD.


METHODS
Outpatient pulmonary rehabilitation program at 2 teaching hospitals.


METHODS
Seventy-five patients with COPD (44 men) in a stable clinical state with mean age 70 years (SD 9 y), forced expiratory volume in one second 52% (SD 21%) predicted and baseline walking distance 359 meters (SD 104 m).


METHODS
Not applicable.


METHODS
Participants completed the six-minute walk test before and after a 7-week pulmonary rehabilitation program. Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD.


RESULTS
The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters, compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change (P=.004). Anchor-based methods identified an MID of 25 meters (95% confidence interval 20-61 m). There was excellent agreement with distribution-based methods (25.5-26.5m, kappa=.95). A change in 6MWD of 14% compared with baseline also represented a clinically important effect; this threshold was less sensitive than for absolute change (sensitivity .70 vs .85).


CONCLUSIONS
The MID for 6MWD in COPD is 25 meters. Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline. These data support the use of 6MWD as a patient-important outcome in research and clinical practice.
Holland
Anne E
AE
School of Physiotherapy, La Trobe University, Melbourne, Australia. a.holland@alfred.org.au
Hill
Catherine J
CJ
Rasekaba
Tshepo
T
Lee
Annemarie
A
Naughton
Matthew T
MT
McDonald
Christine F
CF
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D012647:Self-Assessment; D016138:Walking / Q000502:physiology*