Chest
Volume 140, Issue 3, September 2011, Pages 737-743
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Original Research
Pulmonary Rehabilitation
Properties of Self-Paced Walking in Chronic Respiratory Disease: A Patient Goal-Oriented Assessment

https://doi.org/10.1378/chest.10-3104Get rights and content

Background

Patients with chronic respiratory diseases often have the simple goal of wanting to walk for longer. We evaluated the properties of a patient goal-oriented, symptom-limited, self-paced walk (SPW).

Methods

Patients with symptomatic chronic respiratory disease, referred for a 6-week course of pulmonary rehabilitation (PR), were screened for eligibility. Baseline assessments included two SPWs with both time and speed measured, two 6-min walk tests (6MWTs), and the Medical Research Council dyspnea scale. On program completion, two SPWs and one 6MWT were performed. The repeatability, responsiveness, and validity of the SPW were assessed.

Results

Two SPWs were completed by 50 and 37 patients before and after rehabilitation, respectively. The speed (r = −0.54, P < .001) but not the time (r = −0.23, P = .19) of the SPW correlated with Medical Research Council dyspnea grade. The mean SPW time increased on the second day of testing from 15.1 ± 8.4 min to 17.9 ± 7.7 min (P = .004), and the effect of test day was unaltered by PR (P = .80). The coefficient of repeatability for SPW time was 16.1 min. Both the mean SPW time (10.6 min; 95% CI, 6.6-14.5 min; P < .001) and the mean speed (3.5 m/min; 95% CI, 1.3-5.7 m/min; P < .01) increased after rehabilitation.

Conclusions

The SPW time is an easily understandable, patient goal-oriented assessment with construct validity that is highly responsive to the effects of PR. The variability in SPW time makes it better suited to interpreting group rather than individual changes.

Trial registry

ClinicalTrials.gov; No.: NCT00781183; URL: www.clinicaltrials.gov

Section snippets

Study Design

Patients were prospectively recruited to this longitudinal, single-group study at the start of their PR program. During the first week, the following assessments were conducted: two SPWs on separate days; two 6MWTs conducted according to American Thoracic Society guidelines,3 with the second test being used for analysis; functional limitation resulting from dyspnea using the Medical Research Council (MRC) dyspnea scale13, 14; and spirometry (Elite DL; Medical Graphics Corp; St. Paul, Minnesota)

Results

A total of 124 patients were screened for eligibility, and 64 (52%) consented to participate in the study. Their characteristics are summarized in Table 1. Supplemental oxygen was used in 40% of participants and a wheeled walker (rollator) in 50%. The reasons participants were excluded from analysis are provided in Figure 1. Two SPWs were completed before and after the program in 50 and 37 participants, respectively. Compared with those who completed two SPWs, those who did not had a lower 6MWT

Discussion

SPW is used to monitor walking performance in PR programs. To our knowledge, this study is the first to report its construct validity, repeatability and responsiveness as well as the sustainable SPW speed selected by patients with severe chronic respiratory disease. We found that SPW speed demonstrated construct validity and that SPW time was highly responsive to the effects of PR. The repeatability of SPW was unaltered by PR, despite patients walking on a daily basis as part of their program.

Acknowledgments

Author contributions: Dr Goldstein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Evans: contributed to conducting the study, data analysis and interpretation, and preparation of the manuscript.

Dr Hill: contributed to the design of the study, data interpretation, and preparation of the manuscript.

Mr Dolmage: contributed to the design of the study, data analysis and interpretation, and preparation of

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    Funding/Support: This study was funded in part by an unrestricted grant from AstraZeneca. Dr Goldstein is funded through the University of Toronto-National Sanitarium Association Chair in Respiratory Rehabilitation Research. Dr Brooks holds a Canada Research Chair.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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