title: Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study.
abstract: OBJECTIVE
  Do patients with chronic obstructive pulmonary disease (COPD) achieve a different distance on the six minute walk test (6MWT) conducted on a 10m course versus on a 30m course? When assessing the distance on a 6MWT conducted on a 10m course, is it valid to use existing reference equations that were generated on longer courses?
  
  
  METHODS
  A randomised double-crossover experimental study.
  
  
  METHODS
  Forty-five patients with COPD in primary physiotherapy care.
  
  
  METHODS
  All patients performed a 6MWT twice over a 10m course and twice over a 30m course. The 6MWTs were performed in accordance with the American Thoracic Society guidelines.
  
  
  METHODS
  6MWD was assessed and predicted distance was calculated based on a range of reference equations.
  
  
  RESULTS
  The 6MWD on the 10m course was 49.5m shorter than on the 30m course, which was statistically significant (95% CI 39.4 to 59.6). By using existing reference equations for a 6MWT conducted on the 10m course, the predicted distance is highly overestimated (with a range of 30% to 33%) and the average distance as a percentage of the predicted value is 8%pred lower compared to a 6MWT conducted on the 30m course, resulting in a worse representation of a COPD patient's functional exercise capacity.
  
  
  CONCLUSIONS
  This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinically relevant (based on the most conservative published minimum clinically important difference). Therefore, existing reference equations established for a 6MWT conducted over a 30m (or longer) course cannot be applied to predict the distance achieved on the 6MWT on a 10m course, which is frequently used in primary care physiotherapy practices for patients with COPD.
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands. E.Beekman@maastrichtuniversity.nl
authors.forename: Emmylou
authors.initials: E
authors.lastname: Beekman
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.forename: Erik J M
authors.initials: EJ
authors.lastname: Hendriks
authors.forename: Mariska P M
authors.initials: MP
authors.lastname: Klaassen
authors.forename: Rik
authors.initials: R
authors.lastname: Gosselink
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: 6-minute walk test; Chronic obstructive pulmonary disease; Course length; Exercise test; Reference values