Cited by 716Cardiovascular and exercise physiologyChronic Obstructive Pulmonary Disease (COPD) ResearchHealth Systems, Economic Evaluations, Quality of Life

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Minimal clinically important difference for change in 6‐minute walk test distance of adults with pathology: a systematic review

Bohannon, Richard W., Crouch, Rebecca·2017·Journal of Evaluation in Clinical Practice

DOI 10.1111/jep.12629

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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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Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities
Willingham, T. B., Stowell, J. F., Collier, G., & Backus, D. A. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21010079 · Cited by 56
A tele-health primary care rehabilitation program improves self-perceived exertion in COVID-19 survivors experiencing Post-COVID fatigue and dyspnea: A quasi-experimental study
Calvo-Paniagua, J., Díaz‐Arribas, M. J., Valera‐Calero, J. A., Gallardo-Vidal, M. I., Fernández‐de‐las‐Peñas, C., López‐de‐Uralde‐Villanueva, I., del Corral, T., & Plaza‐Manzano, G. (2022) · PLoS ONE · doi:10.1371/journal.pone.0271802 · Cited by 52
Clinically relevant differences in COPD health status: systematic review and triangulation
Alma, H. J., de Jong, C., Tsiligianni, I., Sanderman, R., Kocks, J. W. H., & van der Molen, T. (2018) · European Respiratory Journal · doi:10.1183/13993003.00412-2018 · Cited by 50
Evaluation, Acceptance, and Qualification of Digital Measures: From Proof of Concept to Endpoint
Goldsack, J. C., Dowling, A. V., Samuelson, D., Patrick‐Lake, B., & Clay, I. (2021) · Digital Biomarkers · doi:10.1159/000514730 · Cited by 50
“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].”
Result
Exercise before, during, and after Hospitalization for Allogeneic Hematological Stem Cell Transplant: A Feasibility Randomized Controlled Trial
Mina, 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
“clinically important differences (MCID) [37,38] and both groups displayed a reduction in 6 MWT”
BackgroundInfluential
Feasibility of Telerehabilitation for Heart Failure Patients Inaccessible for Outpatient Rehabilitation
Lundgren, 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
“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…”
BackgroundMethodInfluential
Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis
Verweij, 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
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
“5 m between measurements is considered a minimal clinical important difference [21].”
BackgroundMethod
What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials
Bowman, 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
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
“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.”
Method
The safety and feasibility of a new rehabilitation robotic exoskeleton for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI): an observational study
Xiang, 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
“research and clinical tool for assessing changes in endurance and walking ability [18].”
Minimal Clinically Important Differences for Oxford, Constant, and University of California Los Angeles Shoulder Scores After Reverse Shoulder Arthroplasty to Allow Interpretation of Patient‐Reported Outcome Measures and Future Statistical Power Analyses
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
High prevalence of symptomatic spinal stenosis in Norwegian adults with achondroplasia: a population-based study
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
Study in Parkinson’s disease of exercise phase 3 (SPARX3): study protocol for a randomized controlled trial
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 48
“• Functional Capacity: The total distance walked in 6 min is used as a measure of ambulatory mobility [43].”
Method
Longitudinal 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 45
Effect of a 12-week home-based exercise training program on aerobic capacity, muscle mass, liver and spleen stiffness, and quality of life in cirrhotic patients: a randomized controlled clinical trial
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
“5 to 54 m has been widely accepted as representative of clinically significant change [27, 28].”
Preoperative six-minute walk distance as a predictor of postoperative complication in patients with esophageal cancer
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
Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses
Lüthi, F., Vuistiner, P., Favre, C., Hilfiker, R., & Léger, B. (2018) · PLoS ONE · doi:10.1371/journal.pone.0203329 · Cited by 40
“The 6-minute walk test (6MWT)[53], a reliable and validated submaximal exercise test well designed for adults with pathology and chronic pain[54].”
Method
Exercise 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
Effectiveness of exergaming-based interventions for mobility and balance performance in older adults with Parkinson’s disease: systematic review and meta-analysis of randomised controlled trials
Zhang, J., Luximon, Y., Pang, M. Y. C., & Wang, H. (2022) · Age and Ageing · doi:10.1093/ageing/afac175 · Cited by 40
“Minimal clinically important difference” estimates of 6 commonly-used performance tests in patients with chronic musculoskeletal pain completing a work-related multidisciplinary rehabilitation program
Benaïm, C., Blaser, S., Léger, B., Vuistiner, P., & Lüthi, F. (2019) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2382-2 · Cited by 40
Using a two-sample mendelian randomization analysis to explore the relationship between physical activity and Alzheimer’s disease
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 39
Short‐term multimodal prehabilitation improves functional capacity for colorectal cancer patients prior to surgery
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
Effects of Home-Based Pulmonary Rehabilitation on Dyspnea, Exercise Capacity, Quality of Life and Impact of the Disease in COPD Patients: A Systematic Review
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 42
“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].”
Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: A multicenter prospective cohort study (CO-FLOW)
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
Intraoperative pressure sensors improve soft-tissue balance but not clinical outcomes in total knee arthroplasty: a multicentre randomized controlled trial
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
The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: a systematic review and meta-analyses
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
Efficacy of supervised exercise prehabilitation programs to improve major abdominal surgery outcomes: A systematic review and meta-analysis
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
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
“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)”
Lumacaftor/ Ivacaftor improves exercise tolerance in patients with Cystic Fibrosis and severe airflow obstruction
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Sacubitril-valsartan improves conduit vessel function and functional capacity and reduces inflammation in heart failure with reduced ejection fraction
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Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients
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Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study
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“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
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Long‐term pulmonary sequelae in adolescents post‐SARS‐CoV‐2 infection
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“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.”
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Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: A preliminary study with long-term follow-up
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Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis
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 35
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“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.”
BackgroundInfluential
Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials
Soh, 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
Long-Term Survival and Health-Related Quality of Life in Adults After Extra Corporeal Membrane Oxygenation
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
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 33
A modified six-minute walk test (6MWT) for low-resource settings-a cross-sectional study
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Effects of high-intensity interval training on functional performance and maximal oxygen uptake in comparison with moderate intensity continuous training in cancer patients: a systematic review and meta-analysis
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“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
DOI: 10.1111/jep.12629
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Evaluation in Clinical Practice (publishedVersion)
PubMed (publishedVersion)
Funders: Ministerul Cercetării, Inovării şi Digitalizării
Topics: Health Sciences › Medicine › Physiology (medical) › 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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Minimal clinically important difference for change in 6‐minute walk test distance of adults with pathology: a systematic review

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