Using the 6-minute walk test to predict disability-free survival after major surgery

M. A. Shulman, B. H. Cuthbertson, D. N. Wijeysundera, R. M. Pearse, B. Thompson, E. Torres, A. Ambosta, S. Wallace, C. Farrington, P. S. Myles, on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. Methods: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis. Results: Of 574 patients recruited, 567 (99%) completed the 6MWT. Twelve months after surgery, 16 (2.9%) patients had died and 444 (77%) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (ρ=0.14; P=0.001) and 12 month WHO Disability Assessment Schedule (ρ=–0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95% confidence interval (CI): 1.54–6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95% CI: 0.57–0.70) for the 6MWT, 0.60 (95% CI: 0.53–0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95% CI: 0.64–0.76) for the DASI score. Conclusions: Of the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.

Original languageEnglish
Pages (from-to)111-119
Number of pages9
JournalBritish Journal of Anaesthesia
Volume122
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • assessment
  • cardiopulmonary exercise testing
  • exercise test
  • fitness testing
  • patient reported outcomes
  • postoperative outcome
  • risk
  • walk test

Cite this

Shulman, M. A., Cuthbertson, B. H., Wijeysundera, D. N., Pearse, R. M., Thompson, B., Torres, E., ... on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators (2019). Using the 6-minute walk test to predict disability-free survival after major surgery. British Journal of Anaesthesia, 122(1), 111-119. https://doi.org/10.1016/j.bja.2018.08.016
Shulman, M. A. ; Cuthbertson, B. H. ; Wijeysundera, D. N. ; Pearse, R. M. ; Thompson, B. ; Torres, E. ; Ambosta, A. ; Wallace, S. ; Farrington, C. ; Myles, P. S. ; on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators. / Using the 6-minute walk test to predict disability-free survival after major surgery. In: British Journal of Anaesthesia. 2019 ; Vol. 122, No. 1. pp. 111-119.
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abstract = "Background: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. Methods: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis. Results: Of 574 patients recruited, 567 (99{\%}) completed the 6MWT. Twelve months after surgery, 16 (2.9{\%}) patients had died and 444 (77{\%}) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (ρ=0.14; P=0.001) and 12 month WHO Disability Assessment Schedule (ρ=–0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95{\%} confidence interval (CI): 1.54–6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95{\%} CI: 0.57–0.70) for the 6MWT, 0.60 (95{\%} CI: 0.53–0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95{\%} CI: 0.64–0.76) for the DASI score. Conclusions: Of the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.",
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Shulman, MA, Cuthbertson, BH, Wijeysundera, DN, Pearse, RM, Thompson, B, Torres, E, Ambosta, A, Wallace, S, Farrington, C, Myles, PS & on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators 2019, 'Using the 6-minute walk test to predict disability-free survival after major surgery' British Journal of Anaesthesia, vol. 122, no. 1, pp. 111-119. https://doi.org/10.1016/j.bja.2018.08.016

Using the 6-minute walk test to predict disability-free survival after major surgery. / Shulman, M. A.; Cuthbertson, B. H.; Wijeysundera, D. N.; Pearse, R. M.; Thompson, B.; Torres, E.; Ambosta, A.; Wallace, S.; Farrington, C.; Myles, P. S.; on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators.

In: British Journal of Anaesthesia, Vol. 122, No. 1, 01.01.2019, p. 111-119.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Using the 6-minute walk test to predict disability-free survival after major surgery

AU - Shulman, M. A.

AU - Cuthbertson, B. H.

AU - Wijeysundera, D. N.

AU - Pearse, R. M.

AU - Thompson, B.

AU - Torres, E.

AU - Ambosta, A.

AU - Wallace, S.

AU - Farrington, C.

AU - Myles, P. S.

AU - on behalf of the Measurement of Exercise Tolerance for Surgery Study Investigators

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. Methods: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis. Results: Of 574 patients recruited, 567 (99%) completed the 6MWT. Twelve months after surgery, 16 (2.9%) patients had died and 444 (77%) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (ρ=0.14; P=0.001) and 12 month WHO Disability Assessment Schedule (ρ=–0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95% confidence interval (CI): 1.54–6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95% CI: 0.57–0.70) for the 6MWT, 0.60 (95% CI: 0.53–0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95% CI: 0.64–0.76) for the DASI score. Conclusions: Of the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.

AB - Background: The 6-min walk test (6MWT) is a common means of functional assessment. Its relationship to disability-free survival (DFS) is uncertain. Methods: This sub-study of the Measurement of Exercise Tolerance for Surgery study had co-primary outcome measures: correlation of the preoperative 6MWT distance with 30 day quality of recovery (15-item quality of recovery) and 12 month WHO Disability Assessment Schedule scores. The prognostic utility of the 6MWT and other risk assessment tools for 12 month DFS was assessed with logistic regression and receiver-operating-characteristic-curve analysis. Results: Of 574 patients recruited, 567 (99%) completed the 6MWT. Twelve months after surgery, 16 (2.9%) patients had died and 444 (77%) had DFS. The 6MWT correlated weakly with 30 day 15-item quality of recovery (ρ=0.14; P=0.001) and 12 month WHO Disability Assessment Schedule (ρ=–0.23; P<0.0005) scores. When the cohort was split into 6MWT distance tertiles, the adjusted odds ratio of low vs high tertiles for DFS was 3.13 [95% confidence interval (CI): 1.54–6.35]. The only independent variable predictive of DFS was the Duke Activity Status Index (DASI) score (adjusted odds ratio: 1.06; P<0.0005). The area under the receiver-operating-characteristic curve for DFS was 0.63 (95% CI: 0.57–0.70) for the 6MWT, 0.60 (95% CI: 0.53–0.67) for cardiopulmonary-exercise-testing-derived peak oxygen consumption, and 0.70 (95% CI: 0.64–0.76) for the DASI score. Conclusions: Of the risk assessment tools analysed, the DASI was the most predictive of DFS. The 6MWT was safe and comparable with cardiopulmonary exercise testing for all predictive assessments. Future research should aim to determine the optimal 6MWT distance thresholds for risk prediction.

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KW - patient reported outcomes

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