• A self-paced test. It measures the distance that a patient can walk on a flat, hard surface in 6 minutes and assesses the sub-maximal level of functional capacity (American Thoracic Society 2000).
• The test in its entirety evaluates the integrated response of pulmonary, cardiovascular, and circulatory systems, in addition to level of motor control, functional neuromuscular units, and muscle (Ditunno et al. 2007).

Number of items: N/a

Procedure/Administration: The 6MWT may be performed either indoors or outdoors, along a long, flat, straight, and hard surface. The American Thoracic Society (ATS) recommends that the walking course should be 30 meters in length, marked at every 3 meters, and a turnaround point marked with a cone.

How scored: The distance (total distance walked rounding to the nearest meter) is reported. Fatigue level is also reported. Pulse oximetry (baseline heart rate and oxygen saturation) is optional.

Interpretability: For single measurements, reference equations from healthy samples using the 6MWT are not available for comparison.

Acceptability: It is suitable for patients who can walk with moderate or less assistance for 6 minutes. It is a self paced test and subjects may take stop to rest.

Languages: N/a

Usability: N/a

Time to administer: N/a

Time to score: N/a

Training required: People who administer the test should be trained using the standard protocol and then supervised for several tests before performing them alone. The test administrator should also have CPR training.

Availability: N/a

Equipment required: A countdown timer, mechanical lap counter, cones to mark the turnaround, a chair that can be easily moved along the walking course, worksheets, a source of oxygen, sphygmomanometer, telephone, and an automated electronic defibrillator.

Summary:

• According to the American Thoracic Society, the 6MWT is easier to administer, better tolerated, and more reflective of activities of daily living than other walking tests.
• There are many sources of variability including height, age, body weight, sex, and motivation (ATS 2002).

Psychometric Summary:

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

• American Thoracic Society. ATS Statement: Guideline for the Six-Minute Walk Test. Am J Respir Crit Care Med 2002; 166: 111-117.
• Ditunno JF Jr, Barbeau H, Dobkin BH, Elashoff R, Harkema S, Marino RJ, Hauck WW, Apple D, Basso DM, Behrman A, Deforge D, Fugate L, Saulino M, Scott M, Chung J, Spinal Cord Injury Locomotor Trial Group. Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial. Neurorehabil Neural Repair 2007; 21: 539-550.
• van Hedel HJA, Wirz M, Curt A. Improving walking assessment in subjects with incomplete spinal cord injury: responsiveness. Spinal Cord 2006;44:352-356.