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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Self-citation
The minimal detectable change cannot reliably replace the minimal important difference
Turner, D., Schünemann, H. J., Griffith, L. E., Beaton, D., Griffiths, A. M., Critch, J., & Guyatt, G. H. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.01.024 · Cited by 368
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Background
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Illini, O., Valipour, A., Gattinger, D., Petrovic, M., Fabikan, H., Hochmair, M. J., & Zwick, R. H. (2022) · Cancers · doi:10.3390/cancers14143479 · Cited by 14
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“Given the fact that the original MCID for 6MWT was derived from COPD (Bohannon and Crouch, 2017) patients it will be interesting to know in future studies if patients receiving treatment for cancer have a different MCID in terms of 6MWT. Lastly, the body composition parameters especially BMI, Skeletal Mass and total f…”
Method
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Kohlbrenner, D., Aregger, C., Osswald, M., Sievi, N. A., & Clarenbach, C. F. (2021) · Physical Therapy · doi:10.1093/ptj/pzab063 · Cited by 13
mHealth 6-minute walk test – accuracy for detecting clinically relevant differences in heart failure patients
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“The minimal clinically important difference (MCID) in SSWS for adults with gait pathology is 0.08 m/s (Bohannon & Crouch, 2017).”
BackgroundInfluential
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“Sensors 2023, 23, 7238 8 of 21 In addition, pre- and post-treatment clinical outcomes were monitored as follows: • Disability: modified Barthel Index (mBI) [59]; • Respiratory outcomes: Barthel Dyspnea Index (BaDI) [52]; and Borg Scale [60] during Two-Meter Walking Test (2MWT) [61]; • Motor outcomes: 2MWT [61]; • Fati…”
Method
A pilot study to assess the feasibility of a remotely monitored high-intensity interval training program prior to allogeneic hematopoietic stem cell transplantation
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“Likewise, the mean improvement of 50.1 meters in 6MWT distance is greater than the 30.5 meter improvement that has been considered clinically meaningful in other populations [38] and it corresponds to a 9% reduced risk for mortality [15].”
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“A systematic review including six studies of patients with different pathologies revealed a change of 14–35 m as clinically meaningful 36 .”
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“# Clinically relevant change within group from baseline to 3-month follow-up is deﬁned as a di ﬀ erence between mean value at baseline and 3-month follow up of minimum 5% for weight [41], 5 kg for hand grip strength [54], and 14 m for 6-min walk test [55].”
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“5 m across multiple patient groups.([41]) The difference of 6WMD caused by HFNC was 27.”
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“Based on a systematic review recommending 30.5 metres as a minimally important 6-min walk test difference for people with pathologies [26] it is likely that the 100 metre difference found in our meta-analysis is clinically meaningful.”
BackgroundInfluential
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“23 Meanwhile, oxygen (O 2 ) saturation and heart rate were registered every minute by using a pulse oximeter NANOX μ for measuring oxygen saturation and an OMRON M3 device for measuring heart rate.”
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Claeys, K. G., Kushlaf, H. A., Raza, S. I., Hummel, N., Shohet, S., Keyzor, I., Kopiec, A., Graham, R., Fox, B., & Schoser, B. G. H. (2024) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-024-03156-3 · Cited by 12
“The 6-min walk distance (6MWD) assesses patients’ endurance and functional ability, monitors treatment efficacy and disease progression, and has been used in a range of diseases [9, 10].”
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“Some measures, such as gait speed and 6-minute walk test, have been vetted in this manner (53, 96).”
Method
Blocking the activin IIB receptor with bimagrumab ( BYM338 ) increases walking performance: A meta‐analysis
Spitz, R. W., Dankel, S. J., Bell, Z. W., Wong, V. H. Y., Abe, T., Kang, M., & Loenneke, J. P. (2021) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14265 · Cited by 12
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Anchor-based minimal important difference values are often sensitive to the distribution of the change score
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“Secondary outcomes of this study were the change in 6MWT, percentage of patients with a progression on 6MWT of >20 m [29] The CCI is a validated measurement that weighs all complications into a sum score ranging from 0 to 100 [30].”
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“Importantly, such an increase in 6MWT is still regarded as a clinically important difference in adults with pathology (24).”
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“A review of the literature revealed some controversy regarding the minimal important difference of improvements in the 6MWT in COPD patients [8,20,28–30] and across multiple patient groups [20,31].”
Background
Home-Based Pulmonary Rehabilitation and Health Coaching in Fibrotic Interstitial Lung Disease
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“SOD isoenzymes’ activity was determined with the use of the spectrophotometric method by Oyanagui [23].”
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“5 meters in the 6MWT may be clinically important in adults with pathology (4).”
Background
Exercise Training Programs Improve Cardiorespiratory and Functional Fitness in Adults With Asthma
Valkenborghs, S. R., Anderson, S., Scott, H. A., & Callister, R. (2022) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000698 · Cited by 10
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Feasibility, criterion and construct convergent validity of the 2-minute walk test and the 10-meter walk test in an oncological context
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“One of the most widely used field tests to quantify walking capacity is the 6-Minute Walk Test (6MWT) [15].”
Multimodal prehabilitation improves functional capacity in patients with advanced ovarian cancer undergoing cytoreductive surgery
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Randomized Controlled Trial of a Virtually Delivered Exercise and Stress Management Program to Improve Physical Performance of Hematopoietic Cell Transplant Survivors
Ma, D. D. F., Liu, Z., Au, K., Tran, M. J., Artuz, C. M., Greenwood, M. J., Bilmon, I., & Kliman, D. S. (2024) · Journal of Clinical Oncology · doi:10.1200/jco.24.00333 · Cited by 11
The Association Between β-Blocker Use and Cardiorespiratory Fitness: The Maastricht Study
Nielen, J. T. H., de Vries, F., van der Velde, J. H. P. M., Savelberg, H. H. C. M., Schaper, N. C., Dagnelie, P. C., Henry, R. M. A., Schram, M. T., Stehouwer, C. D. A., Boonen, A. E. R. C. H., et al. (2018) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248418778551 · Cited by 10
“5 m, the clinical relevance of the difference found in this study may be limited.(22) Furthermore, the difference in CRF between nonselective and selective BB users was not statistically significant.”
Background
Prehabilitative high-intensity interval training and resistance exercise in patients prior allogeneic stem cell transplantation
Kuehl, R., Feyer, J., Limbach, M., Pahl, A., Stoelzel, F., Beck, H., Wegner, A., Rosenberger, F., Dreger, P., Luft, T., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-49420-7 · Cited by 10
Exploring cognitive reserve’s influence: unveiling the dynamics of digital telerehabilitation in Parkinson’s Disease Resilience
Isernia, S., Tella, S. D., Rossetto, F., Borgnis, F., Realdon, O., Cabinio, M., Pagliari, C., Torchio, A., Castagna, A., Blasi, V., et al. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01113-9 · Cited by 10
“The 6MWD MCID computed (distribution-based approach) was 24.27, in line with the estimated meaningful change reported in the literature 28,29 .”
MethodInfluential
Individually tailored exercise in patients with postural orthostatic tachycardia syndrome related to post-COVID-19 condition – a feasibility study
Svensson, A., Svensson‐Raskh, A., Holmström, L., Hallberg, C., Bezuidenhout, L., Conradsson, D. M., Ståhlberg, M., Bruchfeld, J., Fedorowski, A., & Nygren‐Bonnier, M. (2024) · Scientific Reports · doi:10.1038/s41598-024-71055-5 · Cited by 11
“Compared to other populations with disabilities, an increased distance of 14.0 to 30.5 in 6MWT 57 has been judged as clinically significant, but others argue that 54 m 58 is the minimal change to demonstrate a clinically significant improvement in functional status (e.g. among patients with chronic…”
Influential
Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancer—a clinical case series
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“Patient 4 increased 6MWT by 7m, which is below the 14m considered the minimal clinically meaningful change [31].”
Improvement in 6-min Walk Test Distance Following Treatment for Behavioral Weight Loss and Disinhibited Eating: an Exploratory Secondary Analysis
Wooldridge, J. S., Herbert, M. S., Hernandez, J., Dochat, C., Godfrey, K. M., Gasperi, M., & Afari, N. (2019) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09796-1 · Cited by 10
Self-directed home-based neuromuscular electrical stimulation (NMES) in patients with advanced cancer and poor performance status: a feasibility study
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Effects of two different types of ankle–foot orthoses on gait outcomes in patients with subacute stroke: a randomized crossover trial
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Gait Function in Adults Aged 50 Years and Older With Spina Bifida
Larsen, K. L., Maalen-Johansen, I. K., Rennie, L., & Lidal, I. B. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.10.118 · Cited by 10
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Two-Minute Step Test as a Complement to Six-Minute Walk Test in Subjects With Treated Coronary Artery Disease
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Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation
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Pregnancy reference intervals and exertion and breathlessness ratings for the six minute walk test in healthy nulliparous people
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“In chronically ill older adults, for example, the MCIC is approximately 30 m, and a decrease in the 6MWT distance of ≥ 30 m compared with the lower limit of the reference interval signifies increased mortality in the next 12 months [26,27].”
Background
Minimal clinically important difference of the 6-Minute walk test and daily step count at 3 months following surgery for lumbar spinal stenosis
McIlroy, S., Mah, Y., Tahtis, V., Beddard, A., Bearne, L., Weinman, J. A., & Norton, S. (2025) · European Spine Journal · doi:10.1007/s00586-025-09085-4 · Cited by 9
“For the 6MWD we identified MCIDs of 26 m and 35 m using ODI and walking satisfaction as anchors, respectively, aligning with the distri-bution-based estimate of 34 m and with previous research in other conditions [9 ].”
Influential
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Lung function and collagen 1a levels are associated with changes in 6 min walk test distance during treatment of TB among HIV-infected adults: a prospective cohort study
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“39,40 Given that cancer and its treatments can negatively impact functional capacity, improvements in these outcomes are essential for cancer survivors.”
Background
Functional Performance Measures and Assessment for Older Adults
Avers, D. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-60912-8.00007-5 · Cited by 10
Inspiratory muscle training in addition to whole body vibration for functional and physical outcomes in pre-frail older women: a randomized controlled trial
de Souza, H. C. M., Pessoa, M. F., Clemente, R. D. S., da Silva, A. V., de Andrade, E. A. M., Neves, P. A. F., Fernandes, J., & de Andrade, A. D. (2022) · Age and Ageing · doi:10.1093/ageing/afac083 · Cited by 9
“Although the IMT + WBV and IMTsham + WBV groups were similar in terms of 6MWD, the IMT + WBV group presented an average change of 77 m, which is above what is considered as meaningful clinical change for older adults [31].”
Pulmonary rehabilitation in interstitial lung diseases
Makhdami, N., Farooqi, M. A., Thom-Fernandes, C., & Raghavan, N. (2020) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000700 · Cited by 9
“5 m in patients with lung disease, including those with ILD [14,15].”
Effort Oxygen Saturation and Effort Heart Rate to Detect Exacerbations of Chronic Obstructive Pulmonary Disease or Congestive Heart Failure
Gálvez‐Barrón, C., Álvarez, F. V., Ribas, J., Formiga, F., Chivite, D., Boixeda, R., Iborra, C., & Rodríguez‐Molinero, A. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8010042 · Cited by 9
“The findings in this study describe this latter use, defining important realistic cutpoints (35 and 40 m for COPD and HF, respectively) considering the concept of minimal clinically important difference previously described in other studies (15–30 m [42]).”
Background
A 6-Month Home-Based Functional Electrical Stimulation Program for Foot Drop in a Post-Stroke Patient: Considerations on a Time Course Analysis of Walking Performance
David, R., Billot, M., Ojardias, É., Parratte, B., Manuel Roulaud, B., Ounajim, A., Louis, F., Meklat, H., Foucault, P., Lombard, C., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159204 · Cited by 8
“The 6-MWT distance increased from M0 to M1, M3, and M6 in NO, AFO, and FES conditions (Table 1), but the difference was not clinically significant (<28 m) [18,19].”
Method
Clinical, Health‐Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis
Messier, S. P., Gill, M. E., Mihalko, S. L., Beavers, D. P., Queen, K. T., Miller, G. D., Losina, E., Katz, J. N., Loeser, R. F., DeVita, P., et al. (2023) · Arthritis Care & Research · doi:10.1002/acr.25265 · Cited by 8
Predictors of Success of Inpatient Pulmonary Rehabilitation Program in COPD Patients
Hafner, T., Marolt, T. P., Šelb, J., Grošelj, A., Kosten, T., Simonič, A., Košnik, M., & Korošec, P. (2023) · International Journal of COPD · doi:10.2147/copd.s425087 · Cited by 8
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“…it is advised that the correlation (r) between the change/difference in the outcome of interest and change/difference in the anchor is >0.30, with >0.50 preferred for greater confidence [25], and that the area under the curve from receiver operating characteristic analysis should be ≥ 0.7 [26].”
BackgroundResultInfluential
Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis
Ahler, J. R., Busk, H., Holm, P. M., Bricca, A., Poulsen, D. V., Skou, S. T., & Tang, L. H. (2024) · Preventive Medicine · doi:10.1016/j.ypmed.2024.107966 · Cited by 10
Real-world evaluation of physiotherapist-led exercise prehabilitation and rehabilitation during autologous stem cell transplantation in myeloma: a single-centre experience
Land, J., Luong, M. K., Longden, A., Rabin, N. K., Kyriakou, C. A., Sive, J. I., Fisher, A., Yong, K., & McCourt, O. (2025) · BMJ Open Quality · doi:10.1136/bmjoq-2024-002936 · Cited by 8
“Patient consent for publication Not applicable.”
Artificial Intelligence Image–Assisted Knee Ligament Trauma Repair Efficacy Analysis and Postoperative Femoral Nerve Block Analgesia Effect Research
Hong, G., Zhang, L., Kong, X., & Herbertl, L. (2020) · World Neurosurgery · doi:10.1016/j.wneu.2020.11.122 · Cited by 8
Submaximal Walking Tests: A Review of Clinical Use
Roberts, D. E., Futrell, E., & Toole, E. (2022) · Journal of Clinical Exercise Physiology · doi:10.31189/2165-6193-11.2.62 · Cited by 8
The Effects of Exercise Therapy Moderated by Sex in Rehabilitation of COVID-19
Rausch, L. K., Puchner, B., Fuchshuber, J., Seebacher, B., Löffler‐Ragg, J., Pramsohler, S., Netzer, N. C., & Faulhaber, M. (2022) · International Journal of Sports Medicine · doi:10.1055/a-1866-6092 · Cited by 8
Exercise training as part of multidisciplinary rehabilitation in cancer survivors: an observational study on changes in physical performance and patient-reported outcomes
Weemaes, A. T. R., Weijenberg, M. P., Lenssen, A. F., & Beelen, M. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07351-5 · Cited by 8
“5 m was considered clinically relevant [23].”
Nordic Pole Walking for Individuals With Cancer: A Feasibility Randomized Controlled Trial Assessing Physical Function and Health-Related Quality of Life
Cunningham, E. J., Weaver, R. R., Lemonde, M., Dogra, S., & Nonoyama, M. L. (2019) · Rehabilitation Oncology · doi:10.1097/01.reo.0000000000000204 · Cited by 8
Mismatch between subjective and objective motor improvements with adapted tango intervention in older adults
Bennett, C. G., Angel, N., & Hackney, M. E. (2020) · Physiotherapy Research International · doi:10.1002/pri.1835 · Cited by 8
Anthropometric and blood pressure changes in patients with or without nutritional counselling during cardiac rehabilitation: a retrospective study
Valentino, G., Galgani, J. E., Álamos, M. F., Orellana, L., Adasme, M., Berríos, A. I. B., & Mónica Acevedo, B. (2020) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12823 · Cited by 9
Does tension applied in kinesio taping affect pain or function in older women with knee osteoarthritis? A randomised controlled trial
Pinheiro, Y. T., Barbosa, G. M., Fialho, H. R. F., Silva, C. A. M., Anunciação, J. D. O., Silva, H. J. D. A., de Souza, M. C., & Lins, C. A. D. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-041121 · Cited by 9
Effects of Pilates-Based Exercises on Functional Capacity and Mental Health in Individuals with Schizophrenia: A Pilot Study
Akbaş, E., Erdem, E. U., Guneş, E., Özkan, T. D., & Kınıklı, G. İ. (2021) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2021.1929613 · Cited by 8
“5 m in 6-MWD was reported as clinically important across multiple patient groups (Bohannon and Crouch, 2017).”
Background
Randomised, controlled, open-label pragmatic trial evaluating changes in functional exercise capacity after primary care PU lmonary RE habilitation in patients with long COVID: protocol of the PuRe-COVID trial in Belgium
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Cardiac Autonomic Function and Functional Capacity in Post-COVID-19 Individuals with Systemic Arterial Hypertension
Cunha, E. F. D., Silveira, M. S., Milan‐Mattos, J. C., Cavalini, H. F. S., Ferreira, Á. A., Batista, J. D. S., Uzumaki, L. C., Guimarães, J. P. C., Roriz, P. I. L., Dantas, F. M. D. N. A., et al. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13091391 · Cited by 8
“A systematic review demonstrated that an increase of 37 m in 6MWT distance is clinically signiﬁcant [32].”
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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