Functional exercise capacity evaluated by timed walk tests in myasthenia gravis
Corresponding Author
Yeliz Salci PT, PhD
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Correspondence to: Y. Salcı; e-mail: [email protected]Search for more papers by this authorEcem Karanfil PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorAyla Fil Balkan PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorEbru Çalik Kütükçü PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorAli Naim Ceren PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorFatma Ayvat PT, MSc
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorCan Ebru Bekircan-Kurt MD
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Search for more papers by this authorKadriye Armutlu PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorCorresponding Author
Yeliz Salci PT, PhD
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Correspondence to: Y. Salcı; e-mail: [email protected]Search for more papers by this authorEcem Karanfil PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorAyla Fil Balkan PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorEbru Çalik Kütükçü PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorAli Naim Ceren PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorFatma Ayvat PT, MSc
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorCan Ebru Bekircan-Kurt MD
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Search for more papers by this authorKadriye Armutlu PT
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey
Search for more papers by this authorConflicts of Interest: The authors declare that they have no conflicts of interest.
ABSTRACT
Introduction: We sought to evaluate the test–retest reliability and construct validity of the 6- and 2-minute walk tests (6mWT and 2mWT, respectively) in patients with myasthenia gravis (MG). Methods: Thirty-one patients with generalized MG were enrolled in this study. The 6mWT, 2mWT, MG-specific quality of life questionnaire Turkish version (MG-QoL15T), quantitative myasthenia gravis test (QMG), and pulmonary function tests were administered. Results: The intraclass correlation coefficients of 2mWT and 6mWT were 0.894 and 0.932, respectively. The 6mWT and 2mWT had moderate correlations with forced vital capacity, maximal inspiratory pressure, QMG score, and MG-QoL15T score (ρ for 6mWT: 0.579, 0.539, −0.572, and −0.474; ρ for 2mWT: 0.460, 0.446, −0.532, −0.457). Both tests had similar performances for predicting disease severity (area under the curve = 0.761 for 6mWT and 0.759 for 2mWT). Discussion: The 6mWT and 2mWT have excellent test–retest reliability as well as moderate construct validity for the evaluation of functional exercise capacity patients with MG. Muscle Nerve 59:208–212, 2019
REFERENCES
- 1Verschuuren JJ, Huijbers MG, Plomp JJ, Niks EH, Molenaar PC, Martinez-Martinez P, et al. Pathophysiology of myasthenia gravis with antibodies to the acetylcholine receptor, muscle-specific kinase and low-density lipoprotein receptor-related protein 4. Autoimmun Rev 2013; 12(9) 918–923.
- 2Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol 2015; 14(10): 1023–1036.
- 3Elsais A, Johansen B, Kerty E. Airway limitation and exercise intolerance in well-regulated myasthenia gravis patients. Acta Neurol Scand Suppl 2010; 122(190): 12–17.
- 4Wolfsegger T, Stieglbauer K, Topakian R, Weiss E, Aichner F. Belastungsintensitäten für ein Ausdauer-und Krafttraining bei Patienten mit myasthenia gravis. Deutsche Zeitschrift fur Sportmedizin 2011; 62(5): 125.
- 5Feasson L, Camdessanché J-P, El Mhandi L, Calmels P, Millet G. Fatigue and neuromuscular diseases [in English, French]. Ann Réadap Méd Phys 2006; 49(6): 289-300, 375–384.
- 6 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166(1): 111–117.
- 7Zugck C, Krüger C, Dürr S, Gerber S, Haunstetter A, Hornig K, et al. Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Eur Heart J 2000; 21(7): 540–549.
- 8Hamilton DM, Haennel R. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. J Cardiopulm Rehabil 2000; 20(3): 156–164.
- 9Savci S, Inal-Ince D, Arikan H, Guclu-Gunduz A, Cetisli-Korkmaz N, Armutlu K, et al. Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis. Disabil Rehabil 2005; 27(22): 1365–1371.
- 10du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, et al. Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Am J Respir Crit Care Med 2011; 183(9): 1231.
- 11Gijbels D, Eijnde B, Feys P. Comparison of the 2-and 6-minute walk test in multiple sclerosis. Mult Scler 2011; 17(10): 1269–1272.
- 12Roitman JL, Kalra S. Reliability, validity, and responsiveness of a 2-min walk test to assess exercise capacity of COPD patients. J Cardiopulm Rehabil 2007; 27(2): 116.
- 13Brooks D, Parsons J, Tran D, Jeng B, Gorczyca B, Newton J, et al. The two-minute walk test as a measure of functional capacity in cardiac surgery patients. Arch Phys Med Rehabil 2004; 85(9): 1525–1530.
- 14Andersen LK, Knak KL, Witting N, Vissing J. Two-and 6-minute walk tests assess walking capability equally in neuromuscular diseases. Neurology 2016; 86(5): 442–445.
- 15Barohn RJ, McIntire D, Herbelin L, Wolfe GI, Nations S, Bryan WW. Reliability testing of the quantitative myasthenia gravis score. Ann N Y Acad Sci 1998; 841(1): 769–772.
- 16Laszlo G. European standards for lung function testing: 1993 update. Thorax 1993; 48(9): 873.
- 17Hamnegard C, Wragg S, Kyroussis D, Aquilina R, Moxham J, Green M. Portable measurement of maximum mouth pressures. Eur Respir J 1994; 7(2): 398–401.
- 18Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 1969; 99(5): 696–702.
- 19Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care 2009; 54(10): 1348–1359.
- 20Bohannon RW, Wang Y-C, Gershon RC. Two-minute walk test performance by adults 18 to 85 years: normative values, reliability, and responsiveness. Arch Phys Med Rehabil 2015; 96(3): 472–477.
- 21Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158(5): 1384–1387.
- 22Burns TM, Sadjadi R, Utsugisawa K, Gwathmey KG, Joshi A, Jones S, et al. International clinimetric evaluation of the MG-QOL15, resulting in slight revision and subsequent validation of the MG-QOL15r. Muscle Nerve 2016; 54(6): 1015–1022.
- 23Taşcilar NF, Saraçli Ö, Kurcer MA, Ankarali H, Emre U. Reliability and validity of the Turkish version of myasthenia gravis-quality of life questionnaire-15 item. Turk J Med Sci 2016; 46(4): 1107–1113.
- 24Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 2010; 10(1): 22.
- 25Dancey CP, Reidy J. Statistics without maths for psychology. London, United Kingdom: Pearson Education; 2007.
- 26Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39(2): 175–191.
- 27Gibbons WJ, Fruchter N, Sloan S, Levy RD. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 2001; 21(2): 87–93.
- 28Crescimanno G, Modica R, Mauro RL, Musumeci O, Toscano A, Marrone O. Role of the cardio-pulmonary exercise test and six-minute walking test in the evaluation of exercise performance in patients with late-onset Pompe disease. Neuromuscul Disord 2015; 25(7): 542–547.
- 29McDonald CM, Henricson EK, Abresch RT, Florence J, Eagle M, Gappmaier E, et al. The 6-minute walk test and other clinical endpoints in duchenne muscular dystrophy: reliability, concurrent validity, and minimal clinically important differences from a multicenter study. Muscle Nerve 2013; 48(3): 357–368.
- 30Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J 1999; 14(2): 270–274.
- 31Casanova C, Celli B, Barria P, Casas A, Cote C, De Torres J, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J 2011; 37(1): 150–156.
- 32Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55–75 years. Respir Med 2006; 100(4): 658–665.
- 33Wijkstra P, TenVergert E, van der Mark T, Postma D, Van Altena R, Kraan J, et al. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax 1994; 49(5): 468–472.
- 34Dourado VZ, de Oliveira Antunes LC, Tanni SE, de Paiva SAR, Padovani CR, Godoy I. Relationship of upper-limb and thoracic muscle strength to 6-min walk distance in COPD patients. Chest 2006; 129(3): 551–557.