Minimal clinically important difference for change in 6‐minute walk test distance of adults with pathology: a systematic review
Abstract
Rationale, aims, and objectives: The 6‐minute walk test (6MWT) is widely used as a test of functional exercise capacity. Several studies have reported the minimal clinically important difference (MCID) for the 6MWT; however, the findings of the studies have not been examined in the context of one another. In this review, we aimed to summarize available information on the MCID for the 6MWT performed by patients with pathology. Methods: Relevant literature was identified by searches of 3 electronic databases (PubMed, Scopus, and Cumulative Index of Nursing and Allied Health), examination of article reference lists, and consultation with an expert. Inclusion necessitated that articles (1) be original, full length, and peer reviewed, (2) report an MCID for the 6MWT, and (3) focus on adults with medical issues. Articles were excluded if the MCID was determined by a procedure other than receiver operating characteristic curve analysis. Articles were abstracted for information on participants, interventions, 6MWT distance, and the determination of MCID. Quality was assessed using a hybrid 9‐item (0‐ to 18‐point) instrument. Results: Six articles were selected based on the inclusion and exclusion criteria. The populations studied included people with chronic obstructive pulmonary disease, lung cancer, coronary artery disease, diffuse parenchymal lung disease, and non–cystic fibrosis bronchiectasis and adults with fear of falling. Mean baseline 6MWT distances ranged from 295 to 551 m. The MCIDs for which the area under the receiver operating characteristic curve was at least 0.70 ranged from 14.0 to 30.5 m. Conclusions: Based on our findings, a change of 14.0 to 30.5 m may be clinically important across multiple patient groups.
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A change of 14.0 to 30.5 meters on the 6-minute walk test is clinically important.
“A change of 14.0 to 30.5 meters is clinically important for 6MWT [35];”
From Pilot study of a telehealth perioperative physical activity intervention for older adults with cancer and their caregivers (2020) · cites this paper as [35]
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“This is similar to an established outcome measure gaining traction in other indications over time and becoming a generally accepted measure of a COI or MAH [60].”
ResultMina, D. S., Dolan, L. B., Lipton, J. H., Au, D., Pérez, E. C., Franzese, A., Alibhai, S. M. H., Jones, J. M., & Chang, E. B. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061854 · Cited by 49 · see citing works
“clinically important differences (MCID) [37,38] and both groups displayed a reduction in 6 MWT”
BackgroundInfluentialLundgren, K. M., Langlo, K. A. R., Salvesen, Ø. O., Zanaboni, P., Cittanti, E., Mo, R., Ellingsen, Ø., Dalen, H., & Aksetøy, I. A. (2023) · ESC Heart Failure · doi:10.1002/ehf2.14405 · Cited by 47 · see citing works
“Using the 6MWT, the control group increased their walking distance by 15 m, which is also within the range of clinical significance.(29) As the included participants were either unable or unwilling to participate in outpatient CR, both suboptimal adherence to the intervention and supranormal adherence to guidelines in…”
BackgroundMethodInfluentialVerweij, L., van de Korput, E., Daams, J. G., ter Riet, G., Peters, R. J. G., Engelbert, R., Reimer, W. J. M. S. O., & Buurman, B. M. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2018.05.010 · Cited by 46 · see citing works
Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism
Nopp, S., Klok, F. A., Moik, F., Petrovic, M., Derka, I., Ay, C., & Zwick, R. H. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061811 · Cited by 49 · see citing works
“5 m between measurements is considered a minimal clinical important difference [21].”
BackgroundMethodBowman, T., on behalf of "CICERONE" Italian Consensus Group for Robotic Rehabilitation, Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., BURINI, A., Castelli, E., et al. (2021) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.21.06692-2 · Cited by 46 · see citing works
Randomized controlled trial of N -acetylcysteine therapy for RYR1 -related myopathies
Todd, J. J., Lawal, T. A., Witherspoon, J. W., Chrismer, I. C., Razaqyar, M. S., Punjabi, M., Elliott, J. S., Tounkara, F., Kuo, A., Shelton, M. O., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000008872 · Cited by 46 · see citing works
“We established an RYR1-RM MCID for 6MWT distance of 25–83 m, which fell within the MCID range for Duchenne muscular dystrophy (29 m) and a broad range of other diseases (range 14–31 m).(29) The relatively wide 6MWT MCID range for RYR1-RM likely reflects the clinical heterogeneity of the disease.”
MethodXiang, X.-N., Ding, M., Zong, H.-Y., Liu, Y., Cheng, H., He, C., & He, H. (2020) · Spinal Cord · doi:10.1038/s41393-020-0423-9 · Cited by 46 · see citing works
“research and clinical tool for assessing changes in endurance and walking ability [18].”
Zhou, A., Xu, S., Yew, K. S. A., & Lie, D. T. T. (2022) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2022.12.027 · Cited by 45 · see citing works
Fredwall, S. O., Steen, U., de Vries, O., Rustad, C. F., Eggesbø, H. B., Weedon‐Fekjær, H., Lidal, I. B., Savarirayan, R., & Månum, G. (2020) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-020-01397-6 · Cited by 45 · see citing works
Patterson, C. G., Joslin, E., Gil, A. B., Spigle, W. A., Nemet, T., Chahine, L. M., Christiansen, C. L., Melanson, E., Kohrt, W. M., Mancini, M., et al. (2022) · Trials · doi:10.1186/s13063-022-06703-0 · Cited by 44 · see citing works
“• Functional Capacity: The total distance walked in 6 min is used as a measure of ambulatory mobility [43].”
MethodLongitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry
McKleroy, W., Shing, T. L., Anderson, W. H., Arjomandi, M., Awan, H. A., Barjaktarević, I., Barr, R. G., Bleecker, E. R., Boscardin, W. J., Bowler, R. P., et al. (2023) · JAMA · doi:10.1001/jama.2023.11676 · Cited by 43 · see citing works
Sirisunhirun, P., Bandidniyamanon, W., Jrerattakon, Y., Muangsomboon, K., Pramyothin, P., Nimanong, S., Tanwandee, T., Charatcharoenwitthaya, P., Chainuvati, S. P., & Chotiyaputta, W. (2022) · BMC Gastroenterology · doi:10.1186/s12876-022-02147-7 · Cited by 42 · see citing works
“5 to 54 m has been widely accepted as representative of clinically significant change [27, 28].”
Inoue, T., Ito, S., Kanda, M., Niwa, Y., Nagaya, M., Nishida, Y., Hasegawa, Y., Koike, M., & Kodera, Y. (2019) · Diseases of the Esophagus · doi:10.1093/dote/doz050 · Cited by 42 · see citing works
Lüthi, F., Vuistiner, P., Favre, C., Hilfiker, R., & Léger, B. (2018) · PLoS ONE · doi:10.1371/journal.pone.0203329 · Cited by 40 · see citing works
“The 6-minute walk test (6MWT)[53], a reliable and validated submaximal exercise test well designed for adults with pathology and chronic pain[54].”
MethodExercise Medicine in the Management of Pancreatic Cancer
Luo, H., Galvao, D. A., Newton, R. U., López, P., Tang, C., Fairman, C. M., Spry, N. A., & Taaffe, D. R. (2021) · Pancreas · doi:10.1097/mpa.0000000000001753 · Cited by 41 · see citing works
Zhang, J., Luximon, Y., Pang, M. Y. C., & Wang, H. (2022) · Age and Ageing · doi:10.1093/ageing/afac175 · Cited by 40 · see citing works
Benaïm, C., Blaser, S., Léger, B., Vuistiner, P., & Lüthi, F. (2019) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2382-2 · Cited by 40 · see citing works
Zhang, B., Huang, X., Wang, X., Chen, X., Zheng, C., Shao, W., Wang, G., & Zhang, W. (2022) · Scientific Reports · doi:10.1038/s41598-022-17207-x · Cited by 38 · see citing works
Suen, M., Liew, A., Turner, J. D., Khatri, S., Lin, Y., Raso, K.-L., & Vardy, J. L. (2021) · Asia-Pacific Journal of Clinical Oncology · doi:10.1111/ajco.13564 · Cited by 37 · see citing works
Xavier, D. M., Galvão, E. L., Fonseca, A. A., de Souza, G. M., & Lima, V. P. (2022) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2021.2020234 · Cited by 37 · see citing works
“According to the literature, an increase in the distance walked of 30 m is considered a minimally important difference (MID) intervention in the analysis of adults with COPD [68].”
Berentschot, J. C., Heijenbrok‐Kal, M. H., Bek, L. M., Huijts, S. M., van Bommel, J., van Genderen, M. E., Aerts, J. G. J. V., Ribbers, G. M., Hellemons, M. E., van den Berg-Emons, R. J. G., et al. (2022) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2022.100485 · Cited by 37 · see citing works
MacDessi, S. J., Wood, J. A., Diwan, A. D., Harris, I. A., & on behalf of the SENSOR BALANCE Study Group (2022) · The Bone & Joint Journal · doi:10.1302/0301-620x.104b5.bjj-2021-1299.r2 · Cited by 36 · see citing works
Fong, M., Kaner, E., Rowland, M., Graham, H. E., McEvoy, L., Hallsworth, K., Cucato, G., Gibney, C., Nedkova, M., Prentis, J., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286757 · Cited by 37 · see citing works
Duro-Ocana, P., Zambolin, F., Jones, A. W., Bryan, A., Moore, J., Quraishi, T., McPhee, J. S., Degens, H., & Bagley, L. (2023) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2023.111053 · Cited by 36 · see citing works
Gender Differences in Outcomes Following a Pain-Free, Home-Based Exercise Program for Claudication
Manfredini, R., Lamberti, N., Manfredini, F., Straudi, S., Fabbian, F., Rodríguez‐Borrego, M. A., Basaglia, N., Carmona‐Torres, J. M., & López‐Soto, P. J. (2018) · Journal of Women s Health · doi:10.1089/jwh.2018.7113 · Cited by 35 · see citing works
“Sample size calculations indicated that 264 participants were required to be 95% certain that the 90% confidence interval (CI) excluded a difference in the change in PFWD greater than the equivalence limit of 20 m, corresponding to the minimal clinically important difference established in this population.(36)”
Wark, P. A. B., Cookson, K., Thiruchelvam, T., Brannan, J. D., & Dorahy, D. J. (2019) · BMC Pulmonary Medicine · doi:10.1186/s12890-019-0866-y · Cited by 37 · see citing works
Bunsawat, K., Ratchford, S. M., Alpenglow, J. K., Park, S. H., Jarrett, C. L., Stehlik, J., Smith, A. S., Richardson, R. S., & Wray, D. W. (2020) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00454.2020 · Cited by 35 · see citing works
Khan, M. S., Anker, S. D., Friede, T., Jankowska, E. A., Metra, M., Piña, I. L., Coats, A. J. S., Rosano, G. M. C., Roubert, B., Goehring, U.-M., et al. (2022) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2022.10.423 · Cited by 35 · see citing works
Turner, B., Liang, Y., Simmonds, M., Rodríguez, N., Bobadilla, R., & Yin, Z. (2018) · Journal of general internal medicine · doi:10.1007/s11606-017-4244-2 · Cited by 30 · see citing works
Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study
Lezin, E. S., Karafin, M. S., Bruhn, R. L., Chowdhury, D., Qu, L., Bialkowski, W., Merenda, S., D'Andrea, P., McCalla, A., Anderson, L., et al. (2019) · Transfusion · doi:10.1111/trf.15249 · Cited by 34 · see citing works
“5) Primary diagnosis† Acute myeloid leukemia 68 (33) 21 (31) 47 (33) Myelodysplastic syndrome 40 (19) 13 (19) 27 (19) Lymphoma 24 (12) 5 (7) 19 (13) Multiple myeloma 23 (11) 5 (7) 18 (13) Leukemia, other 20 (10) 5 (7) 15 (11) Solid tumor 13 (6) 2 (3) 11 (8) Other heme nonmalignant 12 (6) 8 (12) 4 (3) Chronic lymphocyt…”
Guanxin V for coronary artery disease: A retrospective study
Liang, B., Qu, Y., Zhao, Q., & Gu, N. (2020) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2020.110280 · Cited by 34 · see citing works
Long‐term pulmonary sequelae in adolescents post‐SARS‐CoV‐2 infection
PALACIOS, S. K., Krivchenia, K., Eisner, M., Young, B., Ramilo, O., Mejías, A., Lee, S., & Kopp, B. T. (2022) · Pediatric Pulmonology · doi:10.1002/ppul.26059 · Cited by 31 · see citing works
“for change in 6‐min walk test distance of adults have been reported from 14–30m, but these have not been reported in pediatric populations.(13) Borg dyspnea and fatigue scores post 6MWT were elevated in most of the cohort at initial visit, equivalent to moderate perceived symptoms (Figure 1C, median dyspnea 3.”
Jamieson, A., Chico, T., Jones, S. H., Chaturvedi, N., Hughes, A. D., & Orini, M. (2025) · npj Cardiovascular Health · doi:10.1038/s44325-025-00082-6 · Cited by 39 · see citing works
Madhavan, S., Lim, H., Sivaramakrishnan, A., & Iyer, P. C. (2019) · Scientific Reports · doi:10.1038/s41598-018-37982-w · Cited by 33 · see citing works
Stienen, M. N., Maldaner, N., Joswig, H., Corniola, M. V., Bellut, D., Proemmel, P., Regli, L., Weyerbrock, A., Schaller, K., & Gautschi, O. P. (2019) · Neurosurgical FOCUS · doi:10.3171/2019.2.focus18618 · Cited by 33 · see citing works
Hu, H., Wu, C., Kwok, J. Y. Y., Ho, M., Chau, P. H., Lok, K. Y. W., & Choi, E. P. H. (2023) · American Journal of Nephrology · doi:10.1159/000532109 · Cited by 32 · see citing works
“Given that the minimal clinically important difference for the 6MWT in similar patients is between 14.0 and 30.5 m [37, 38], we estimated the effect size to be moderate to large, with a moderate level of con fi dence in the evidence.”
BackgroundInfluentialSoh, N. H., Yau, C. R. Z., Low, X. Z., Kadir, H. B. A., Fong, W. J., Ramalingam, M. B., Tan, P. L., Ng, K. Y. Y., Hsing, Y. T., Cai, M., et al. (2024) · Annals of Surgical Oncology · doi:10.1245/s10434-024-16527-8 · Cited by 32 · see citing works
Roll, M., Kuys, S. S., Walsh, J., Tronstad, O., Ziegenfuss, M. D., & Mullany, D. V. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.06.1044 · Cited by 31 · see citing works
Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review
Hartley, H., Cassidy, E. E., Bunn, L. M., Kumar, R., Pizer, B. L., Lane, S., & Carter, B. (2019) · The Cerebellum · doi:10.1007/s12311-019-01063-z · Cited by 32 · see citing works
A modified six-minute walk test (6MWT) for low-resource settings-a cross-sectional study
Fell, B., Hanekom, S. D., & Heine, M. (2022) · Heart & Lung · doi:10.1016/j.hrtlng.2021.12.008 · Cited by 32 · see citing works
Neuendorf, T., Haase, R., Schroeder, S., Schumann, M., & Nitzsche, N. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08103-9 · Cited by 32 · see citing works
“The observed improvements [56, 58, 71, 72, 76, 83–86] exceeded the minimal clinically meaningful difference for multiple patient groups (including cancer survivors) of 14–30.5m [93] or 62.5m [94] improvements, respectively.”
Background
- Authors
- Bohannon, R. W., & Crouch, R.
- Affiliations
- Campbell University (US)
- Corresponding author
- Crouch, Rebecca
- ORCID
- Bohannon, Richard W.
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2016-09-04
- Volume
- 23
- Issue
- 2
- Pages
- 377-381
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- OpenAlex
- W2517085950
- Cited by
- 715
- References
- 17
- Citations by year
- 2026: 80 · 2025: 118 · 2024: 88 · 2023: 94 · 2022: 108 · 2021: 75 · 2020: 69 · 2019: 49 · 2018: 22 · 2017: 12
- FWCI
- 6.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministerul Cercetării, Inovării şi Digitalizării
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- minimal clinically important difference, 6-minute walk test, exercise capacity, functional capacity, chronic obstructive pulmonary disease, lung cancer, coronary artery disease, interstitial lung disease, non-cystic fibrosis bronchiectasis, fear of falling, ROC curve
- MeSH terms
- Accidental Falls, Walk Test, Minimal Clinically Important Difference, Bronchiectasis, Coronary Artery Disease, Fear, Humans, Quality of Life, ROC Curve, Lung Diseases, Interstitial, Pulmonary Disease, Chronic Obstructive
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