Determining the minimum important differences for field walking tests in adults with long–term conditions: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Importance
The minimum important difference (MID) for field walking tests aims to improve interpretation of outcomes, but the volume and heterogeneity of MIDs for these tests is challenging. We aimed to determine the MID for the 6-min walk distance (6MWD), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with long-term conditions.
Methods
This systematic review included studies that generated a MID using an anchor-based approach in patients with long-term conditions for the 6MWD, ISWT or ESWT field walking tests. Studies were screened and data extracted by independent reviewers. Meta-analyses were performed using RevMan.
Results
42 studies were included in the analyses, involving n=13 949 participants. Of these, 12 studies involving exercise as an intervention were included in the meta-analyses to produce MIDs, presented as mean (95% confidence interval). The MID for the 6MWD was 25 m (24–26 m) for respiratory conditions, 23 m (8–37 m) for cardiac conditions and 37 m (26–49 m) for neurological/musculoskeletal conditions. The MID for the ISWT was 48 m (39–57 m) for respiratory conditions and 70 m (55–85 m) for cardiac conditions. The MID for ESWT in COPD was 159 s (94–224 s). The pooled MID across conditions within exercise interventions was 26 m (22–40 m) for the 6MWD and 53 m (44–62 m) for the ISWT, with reasonable heterogeneity (I2=48% and I2=47%, respectively).
Conclusion
We propose new MIDs for exercise interventions using anchor-based methodology in long‑term conditions for the 6MWD, ISWT and ESWT. These can be used internationally for meta‑analyses where studies have used different field walking tests, to optimise trial sample size calculations, and for clinical service benchmarking.
The minimum important difference (MID) for field walking tests aims to improve interpretation of outcomes, but the volume and heterogeneity of MIDs for these tests is challenging. We aimed to determine the MID for the 6-min walk distance (6MWD), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with long-term conditions.
Methods
This systematic review included studies that generated a MID using an anchor-based approach in patients with long-term conditions for the 6MWD, ISWT or ESWT field walking tests. Studies were screened and data extracted by independent reviewers. Meta-analyses were performed using RevMan.
Results
42 studies were included in the analyses, involving n=13 949 participants. Of these, 12 studies involving exercise as an intervention were included in the meta-analyses to produce MIDs, presented as mean (95% confidence interval). The MID for the 6MWD was 25 m (24–26 m) for respiratory conditions, 23 m (8–37 m) for cardiac conditions and 37 m (26–49 m) for neurological/musculoskeletal conditions. The MID for the ISWT was 48 m (39–57 m) for respiratory conditions and 70 m (55–85 m) for cardiac conditions. The MID for ESWT in COPD was 159 s (94–224 s). The pooled MID across conditions within exercise interventions was 26 m (22–40 m) for the 6MWD and 53 m (44–62 m) for the ISWT, with reasonable heterogeneity (I2=48% and I2=47%, respectively).
Conclusion
We propose new MIDs for exercise interventions using anchor-based methodology in long‑term conditions for the 6MWD, ISWT and ESWT. These can be used internationally for meta‑analyses where studies have used different field walking tests, to optimise trial sample size calculations, and for clinical service benchmarking.
Date Issued
2025-04-01
Date Acceptance
2025-02-11
Citation
European Respiratory Review, 2025, 34 (176)
ISSN
0905-9180
Publisher
European Respiratory Society
Journal / Book Title
European Respiratory Review
Volume
34
Issue
176
Copyright Statement
Copyright ©The authors 2025 This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40436612
PII: 34/176/240198
Subjects
Humans
Walk Test
Exercise Tolerance
Time Factors
Predictive Value of Tests
Male
Female
Minimal Clinically Important Difference
Reproducibility of Results
Adult
Middle Aged
Lung
Walking
Aged
Respiratory Tract Diseases
Heart Diseases
Prognosis
Exercise Test
Nervous System Diseases
Chronic Disease
Publication Status
Published
Coverage Spatial
England
Article Number
240198
Date Publish Online
2025-05-28