Walking endurance in multiple sclerosis: Meta-analysis of six-minute walk test performance

•The Six Minute Walk Test is a primary endpoint in clinical research and practice.•Healthy controls walk substantially further than persons with multiple sclerosis.•This effect is worsened by disease severity (i.e., disability status).•We identified encouragement and course layout as moderator varia...

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Bibliographic Details
Published in:Gait & posture 2019-09, Vol.73, p.147-153
Main Authors: Cederberg, Katie L.J., Sikes, E.Morghen, Bartolucci, Alfred A., Motl, Robert W.
Format: Article
Language:English
Subjects:
Disabled Persons
Endurance walking capacity
Humans
Multiple sclerosis
Multiple Sclerosis - physiopathology
Physical Endurance - physiology
Six-minute walk test
Walk Test
Walking - physiology
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Summary:•The Six Minute Walk Test is a primary endpoint in clinical research and practice.•Healthy controls walk substantially further than persons with multiple sclerosis.•This effect is worsened by disease severity (i.e., disability status).•We identified encouragement and course layout as moderator variables of this effect.•We provide expected values for Six-Minute Walk performance in multiple sclerosis. The 6-minute walk (6 MW) is the most commonly applied measure of endurance walking capacity in persons with multiple sclerosis (MS); however, we are not aware of a quantitative synthesis of 6 MW performance in MS. We undertook a meta-analysis quantifying the overall magnitude of difference in 6 MW performance between MS and healthy controls (HCs), and then within MS as a function of disability status. We further examined possible moderator variables of 6 MW performance. The systematic search was conducted for articles that included the 6 MW in persons with MS and involved comparison groups (i.e., HCs or MS disability subgroups (i.e., mild vs moderate-to-severe disability status)). The mean and standard deviation of the distance traveled during the 6 MW as well as sample sizes were entered into Comprehensive Meta-Analysis software and we estimated the overall effect size (Cohen’s d) using a random effects model and examined categorical variables as possible moderators (e.g., instruction protocol, provision of encouragement, method of distance measurement, and course description). Thirty-four studies met inclusion criteria with a total sample size of 3204 persons (MS: 2683; HC: 521) yielding 42 total comparisons. Persons with MS walked a shorter distance than HCs (mean difference = –177.2 ± 19.1 m) with a large effect size (d = – 1.87). Persons with mild disability walked further than those with moderate-to-severe disability (mean difference = 185.19 ± 9.2 m) with a large effect (d = 1.83). The categorical variables of provision of encouragement and course layout moderated the effect of MS and course layout moderated the effect of disability status on 6 MW performance. This meta-analysis of 6 MW performance defines mean difference in 6 MW performance in MS compared with HCs and provides an estimate of the disease-related effect of MS on endurance walking capacity for application within clinical research and practice.
ISSN:0966-6362
1879-2219
DOI:10.1016/j.gaitpost.2019.07.125