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Reliability of the 6-minute walking test smartphone application


Stienen, Martin N; Gautschi, Oliver P; Staartjes, Victor E; Maldaner, Nicolai; Sosnova, Marketa; Ho, Allen L; Veeravagu, Anand; Desai, Atman; Zygourakis, Corinna C; Park, Jon; Regli, Luca; Ratliff, John K (2019). Reliability of the 6-minute walking test smartphone application. Journal of Neurosurgery. Spine, 31(6):786-793.

Abstract

Objective: functional measures such as the 6-minute walking test (6WT) are increasingly applied to evaluate patients with degenerative diseases of the lumbar spine before and after (surgical) treatment. However, the traditional 6WT is cumbersome to apply, as it requires specialized in-hospital infrastructure and personnel. The authors set out to compare 6-minute walking distance (6WD) measurements obtained with a newly developed smartphone application (app) and those obtained with the gold-standard distance wheel (DW).</jats:sec><jats:sec>
METHODS: The authors developed a free iOS- and Android-based smartphone app that allows patients to measure the 6WD in their home environment using global positioning system (GPS) coordinates. In a laboratory setting, the authors obtained 6WD measurements over a range of smartphone models, testing environments, and walking patterns and speeds. The main outcome was the relative measurement error (rME; in percent of 6WD), with |rME| &lt; 7.5% defined as reliable. The intraclass correlation coefficient (ICC) for agreement between app- and DW-based 6WD was calculated.</jats:sec><jats:sec>
RESULTS: Measurements (n = 406) were reliable with all smartphone types in neighborhood, nature, and city environments (without high buildings), as well as with unspecified, straight, continuous, and stop-and-go walking patterns (ICC = 0.97, 95% CI 0.97–0.98, p &lt; 0.001). Measurements were unreliable indoors, in city areas with high buildings, and for predominantly rectangular walking courses. Walking speed had an influence on the ME, with worse accuracy (2% higher rME) for every kilometer per hour slower walking pace (95% CI 1.4%–2.5%, p &lt; 0.001). Mathematical adjustment of the app-based 6WD for velocity-dependent error mitigated the rME (p &lt; 0.011), attenuated velocity dependence (p = 0.362), and had a positive effect on accuracy (ICC = 0.98, 95% CI 0.98–0.99, p &lt; 0.001).</jats:sec><jats:sec>
CONCLUSIONS: The new, free, spine-specific 6WT smartphone app measures the 6WD conveniently by using GPS coordinates, empowering patients to independently determine their functional status before and after (surgical) treatment. Measurements of 6WD obtained for the target population under the recommended circumstances are highly reliable.</jats:sec>

Abstract

Objective: functional measures such as the 6-minute walking test (6WT) are increasingly applied to evaluate patients with degenerative diseases of the lumbar spine before and after (surgical) treatment. However, the traditional 6WT is cumbersome to apply, as it requires specialized in-hospital infrastructure and personnel. The authors set out to compare 6-minute walking distance (6WD) measurements obtained with a newly developed smartphone application (app) and those obtained with the gold-standard distance wheel (DW).</jats:sec><jats:sec>
METHODS: The authors developed a free iOS- and Android-based smartphone app that allows patients to measure the 6WD in their home environment using global positioning system (GPS) coordinates. In a laboratory setting, the authors obtained 6WD measurements over a range of smartphone models, testing environments, and walking patterns and speeds. The main outcome was the relative measurement error (rME; in percent of 6WD), with |rME| &lt; 7.5% defined as reliable. The intraclass correlation coefficient (ICC) for agreement between app- and DW-based 6WD was calculated.</jats:sec><jats:sec>
RESULTS: Measurements (n = 406) were reliable with all smartphone types in neighborhood, nature, and city environments (without high buildings), as well as with unspecified, straight, continuous, and stop-and-go walking patterns (ICC = 0.97, 95% CI 0.97–0.98, p &lt; 0.001). Measurements were unreliable indoors, in city areas with high buildings, and for predominantly rectangular walking courses. Walking speed had an influence on the ME, with worse accuracy (2% higher rME) for every kilometer per hour slower walking pace (95% CI 1.4%–2.5%, p &lt; 0.001). Mathematical adjustment of the app-based 6WD for velocity-dependent error mitigated the rME (p &lt; 0.011), attenuated velocity dependence (p = 0.362), and had a positive effect on accuracy (ICC = 0.98, 95% CI 0.98–0.99, p &lt; 0.001).</jats:sec><jats:sec>
CONCLUSIONS: The new, free, spine-specific 6WT smartphone app measures the 6WD conveniently by using GPS coordinates, empowering patients to independently determine their functional status before and after (surgical) treatment. Measurements of 6WD obtained for the target population under the recommended circumstances are highly reliable.</jats:sec>

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Life Sciences > Neurology
Health Sciences > Neurology (clinical)
Uncontrolled Keywords:General Medicine, 5R-STS = five-repetition sit-to-stand; 6-minute walking test; 6WD = 6-minute walking distance; 6WT = 6-minute walking test; DDD = degenerative disc disease; DTFS = distance to first symptoms; DW = distance wheel; GPS = global positioning system; ICC = intraclass correlation coefficient; LBP = low-back pain; LSS = lumbar spinal stenosis; OFI = objective functional impairment; PROM = patient-reported outcome measure; TTFS = time to first symptoms; TUG = Timed Up and Go; app = application; degenerative disc disease; global positioning system; lumbar spinal stenosis; objective functional impairment; rME = relative measurement error; smartphone app
Language:English
Date:1 December 2019
Deposited On:17 Oct 2019 12:02
Last Modified:29 Jul 2020 11:29
Publisher:American Association of Neurological Surgeons
ISSN:1547-5646
OA Status:Closed
Publisher DOI:https://doi.org/10.3171/2019.6.spine19559
PubMed ID:31518975

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