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01-06-2016

The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties

Authors: Nicolò Pecorelli, Julio F. Fiore Jr., Chelsia Gillis, Rashami Awasthi, Benjamin Mappin-Kasirer, Petru Niculiseanu, Gerald M. Fried, Francesco Carli, Liane S. Feldman

Published in: Surgical Endoscopy | Issue 6/2016

Abstract

Introduction

Patients, clinicians and researchers seek an easy, reproducible and valid measure of postoperative recovery. The six-minute walk test (6MWT) is a low-cost measure of physical function, which is a relevant dimension of recovery. The aim of the present study was to contribute further evidence for the validity of the 6MWT as a measure of postoperative recovery after colorectal surgery.

Methods

This study involved a sample of 174 patients enrolled in three previous randomized controlled trials. Construct validity was assessed by testing the hypotheses that the distance walked in 6 min (6MWD) at 4 weeks after surgery is greater (1) in younger versus older patients, (2) in patients with higher preoperative physical status versus lower, (3) after laparoscopic versus open surgery, (4) in patients without postoperative complications versus with postoperative complications; and that 6MWD (5) correlates cross-sectionally with self-reported physical activity as measured with a questionnaire (CHAMPS). Statistical analysis was performed using linear regression and Spearman’s correlation. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to guide the formulation of hypotheses and reporting of results.

Results

One hundred and fifty-one patients who completed the 6MWT at 4 weeks after surgery were included in the analysis. All hypotheses tested for construct validity were supported by the data. Older age, poorer physical status, open surgery and occurrence of postoperative complications were associated with clinically relevant reduction in 6MWD (>19 m). There was a moderate positive correlation between 6MWD and patient-reported physical activity (r = 0.46).

Conclusions

This study contributes further evidence for the construct validity of the 6MWT as a measure of postoperative recovery after colorectal surgery. Results from this study support the use of the 6MWT as an outcome measure in studies evaluating interventions aimed to improve postoperative recovery.

Kehlet H (2011) Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg 396:585–590CrossRefPubMed

Feldman LS, Lee L, Fiore J Jr (2015) What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways? Can J Anaesth 62:120–130CrossRefPubMed

Lee L, Tran T, Mayo NE, Carli F, Feldman LS (2014) What does it really mean to “recover” from an operation? Surgery 155:211–216CrossRefPubMed

Neville A, Lee L, Antonescu I, Mayo NE, Vassiliou MC, Fried GM, Feldman LS (2014) Systematic review of outcomes used to evaluate enhanced recovery after surgery. Br J Surg 101:159–170CrossRefPubMed

Tran TT, Kaneva P, Mayo NE, Fried GM, Feldman LS (2014) Short-stay surgery: What really happens after discharge? Surgery 156:20–27CrossRefPubMed

Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199:762–772CrossRefPubMed

Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132:919–923PubMedPubMedCentral

Grady MV, Mascha E, Sessler DI, Kurz A (2012) The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy. Anesth Analg 115:1078–1084CrossRefPubMed

Unver B, Kahraman T, Kalkan S, Yuksel E, Karatosun V (2013) Reliability of the six-minute walk test after total hip arthroplasty. Hip Int 23:541–545CrossRefPubMed

10.

Laboratories ATSCoPSfCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRef

11.

Lee L, Schwartzman K, Carli F, Zavorsky GS, Li C, Charlebois P, Stein B, Liberman AS, Fried GM, Feldman LS (2013) The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection. Anaesthesia 68:811–816CrossRefPubMed

12.

Sinclair RC, Batterham AM, Davies S, Cawthorn L, Danjoux GR (2012) Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery. Br J Anaesth 108:30–35CrossRefPubMed

13.

Moriello C, Mayo NE, Feldman L, Carli F (2008) Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil 89:1083–1089CrossRefPubMed

14.

Kolozsvari NO, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou MC, Fried GM, Feldman LS (2013) Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection. Surg Endosc 27:133–138CrossRefPubMed

15.

Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121:937–947CrossRefPubMed

16.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

17.

Copay AG, Subach BR, Glassman SD, Polly DW Jr, Schuler TC (2007) Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7:541–546CrossRefPubMed

18.

Antonescu I, Scott S, Tran TT, Mayo NE, Feldman LS (2014) Measuring postoperative recovery: What are clinically meaningful differences? Surgery 156:319–327CrossRefPubMed

19.

Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33:1126–1141CrossRefPubMed

20.

Feldman LS, Kaneva P, Demyttenaere S, Carli F, Fried GM, Mayo NE (2009) Validation of a physical activity questionnaire (CHAMPS) as an indicator of postoperative recovery after laparoscopic cholecystectomy. Surgery 146:31–39CrossRefPubMed

21.

Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19:539–549CrossRefPubMedPubMedCentral

22.

Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HC (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22CrossRefPubMedPubMedCentral

23.

Kraemer HC, Morgan GA, Leech NL, Gliner JA, Vaske JJ, Harmon RJ (2003) Measures of clinical significance. J Am Acad Child Adolesc Psychiatry 42:1524–1529CrossRefPubMed

24.

Tveter AT, Dagfinrud H, Moseng T, Holm I (2014) Health-related physical fitness measures: reference values and reference equations for use in clinical practice. Arch Phys Med Rehabil 95:1366–1373CrossRefPubMed

25.

Robinett CS, Vondran MA (1988) Functional ambulation velocity and distance requirements in rural and urban communities. A clinical report. Phys Ther 68:1371–1373PubMed

26.

Ring L, Hofer S, Heuston F, Harris D, O’Boyle CA (2005) Response shift masks the treatment impact on patient reported outcomes (PROs): the example of individual quality of life in edentulous patients. Health Qual Life Outcomes 3:55CrossRefPubMedPubMedCentral

27.

Mayo NE, Feldman L, Scott S, Zavorsky G, Kim DJ, Charlebois P, Stein B, Carli F (2011) Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery 150:505–514CrossRefPubMed

28.

Antonescu I, Carli F, Mayo NE, Feldman LS (2014) Validation of the SF-36 as a measure of postoperative recovery after colorectal surgery. Surg Endosc 28:3168–3178CrossRefPubMed

29.

Brown SR, Mathew R, Keding A, Marshall HC, Brown JM, Jayne DG (2014) The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery. Ann Surg 259:916–923CrossRefPubMed

30.

Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA (2012) Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc 60:967–973CrossRefPubMedPubMedCentral

31.

Sharma A, Sharp DM, Walker LG, Monson JR (2007) Predictors of early postoperative quality of life after elective resection for colorectal cancer. Ann Surg Oncol 14:3435–3442CrossRefPubMed

32.

Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145

33.

Dowson H, Cowie A, Ballard K, Gage H, Rockall T (2008) Systematic review of quality of life following laparoscopic and open colorectal surgery. Colorectal Dis 10:751–768CrossRef

34.

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, Group MCt (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed

35.

Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255:216–221CrossRefPubMed

Title: The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties
Authors: Nicolò Pecorelli
Julio F. Fiore Jr.
Chelsia Gillis
Rashami Awasthi
Benjamin Mappin-Kasirer
Petru Niculiseanu
Gerald M. Fried
Francesco Carli
Liane S. Feldman
Publication date: 01-06-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4478-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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