Has the 6-Min Walk Distance Run Its Course?
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ABSTRACT: The goal of the six minute walk test (6MWT) is to enable patients to walk "as far as possible" as a measure of their functional ability. The impact of the specific walk instructions on patient 6MWT performance is unknown. Patients with pulmonary arterial hypertension (PAH), idiopathic pulmonary fibrosis (IPF), and other interstitial lung diseases (ILD) were recruited to perform four identical 6MWTs with one differing instructional phrase. The standard instruction to walk "as far as possible" was substituted in random order with "as fast as possible," "at your normal pace," or "at a leisurely pace." Twenty-four patients were enrolled and completed all four 6MWTs (10 PAH, 8 IPF, 6 other ILD). Patients attained the greatest distance with the "fast" instruction, exceeding the standard instruction distance by a mean of 52.7 meters (P<0.001). The mean difference between the "fast" and standard walks was 41.5 meters in the PAH group, 66.5 meters in the IPF group, and 53 meters in the other ILD group. Patients do not walk as far as they are able with the standard ATS instruction for 6MWT. Changing the wording from "far" to "fast" may facilitate a better effort and greater distance during the test. It is possible that this modified 6MWT instruction may result in improved accuracy and reproducibility, thereby enhancing its clinical and research trial utility. NCT01789996.Chest 08/2013; 144(6). DOI:10.1378/chest.13-0287 · 7.48 Impact Factor
- Thorax 02/2014; 69(2):107-8. DOI:10.1136/thoraxjnl-2013-204964 · 8.29 Impact Factor
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ABSTRACT: Objective: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. Methods: This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus. Results: Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded. Conclusions: Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH.Chest 06/2014; 146(2). DOI:10.1378/chest.14-0793 · 7.48 Impact Factor
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