Skip to main content
Top
Published in: Journal of Neurology 4/2019

01-04-2019 | Fatigue | Original Communication

Six-minute walk test is reliable and sensitive in detecting response to therapy in CIDP

Authors: Emanuele Spina, Antonietta Topa, Rosa Iodice, Stefano Tozza, Lucia Ruggiero, Raffaele Dubbioso, Marcello Esposito, Pasquale Dolce, Lucio Santoro, Fiore Manganelli

Published in: Journal of Neurology | Issue 4/2019

Login to get access

Abstract

Objective

The current clinical measures (ONLS, R-ODS, mRS, and MRC) may not be so sensitive in capturing minimal variations or measuring fatigue in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Our aim was to assess if 6-min walk test (6MWT) is able to increase the sensitivity in detecting response to therapy and to capture fatigue in CIDP patients.

Methods

We tested 6MWT in 42 CIDP patients. Using both anchor-based and distribution-based approaches, we estimated the meaningful clinical change after therapy by calculating the minimum improvement cutoff (Minimal Clinically Important Difference Score—MCID) required for considering a patient as responder. We calculated the sensitivity of the 6MWT versus the other clinical outcomes. We analysed fatigue by comparing the velocities between first and sixth minutes of the 6MWT and the effect of treatment on fatigue using an ANOVA model for repeated measures.

Results

MCID resulted equal to 20 m. The combination of 6MWT-MCID cutoff with the other clinical measures led to identify 74% of responders. The sensitivity of the 6MWT was 90% versus 77% of the other clinical measures. The 6MWT was also sensitive in capturing fatigue-related changes, even though fatigue was not influenced by treatment.

Conclusions

The combination of the 6MWT with the other clinical measures increased the chance to detect the quote of responders. We propose to include the 6MWT in the routine assessment of CIDP patients and the MCID cutoff at 20 m could be set for identifying the responders and properly guiding the therapy management.
Literature
1.
go back to reference Merkies IS, Schmitz PI, van der Meché FG, van Doorn PA (2000) Psychometric evaluation of a new sensory scale in immune-mediated polyneuropathies. Inflammatory Neuropathy Cause and Treatment (INCAT) Group. Neurology 54(4):943–949CrossRefPubMed Merkies IS, Schmitz PI, van der Meché FG, van Doorn PA (2000) Psychometric evaluation of a new sensory scale in immune-mediated polyneuropathies. Inflammatory Neuropathy Cause and Treatment (INCAT) Group. Neurology 54(4):943–949CrossRefPubMed
2.
go back to reference Graham RC, Hughes RA (2006) A modified peripheral neuropathy scale: the overall neuropathy limitations scale. J Neurol Neurosurg Psychiatry 77(8):973–976 (Epub 2006 Mar 30)CrossRefPubMedPubMedCentral Graham RC, Hughes RA (2006) A modified peripheral neuropathy scale: the overall neuropathy limitations scale. J Neurol Neurosurg Psychiatry 77(8):973–976 (Epub 2006 Mar 30)CrossRefPubMedPubMedCentral
4.
go back to reference Bamford JM, Sandercock PA, Warlow CP, Slattery J (1989) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 20(6):828 (No abstract available)CrossRefPubMed Bamford JM, Sandercock PA, Warlow CP, Slattery J (1989) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 20(6):828 (No abstract available)CrossRefPubMed
5.
go back to reference Kleyweg RP, van der Meché FG, Schmitz PI (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain–Barré syndrome. Muscle Nerve 14(11):1103–1109CrossRefPubMed Kleyweg RP, van der Meché FG, Schmitz PI (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain–Barré syndrome. Muscle Nerve 14(11):1103–1109CrossRefPubMed
6.
go back to reference Padua L, Pazzaglia C, Pareyson D et al (2016) CMT-TRIAAL Group. Novel outcome measures for Charcot-Marie-Tooth disease: validation and reliability of the 6-min walk test and StepWatch(™) Activity Monitor and identification of the walking features related to higher quality of life. Eur J Neurol 23(8):1343–1350. https://doi.org/10.1111/ene.13033 (Epub 2016 May 10)CrossRefPubMed Padua L, Pazzaglia C, Pareyson D et al (2016) CMT-TRIAAL Group. Novel outcome measures for Charcot-Marie-Tooth disease: validation and reliability of the 6-min walk test and StepWatch(™) Activity Monitor and identification of the walking features related to higher quality of life. Eur J Neurol 23(8):1343–1350. https://​doi.​org/​10.​1111/​ene.​13033 (Epub 2016 May 10)CrossRefPubMed
15.
go back to reference Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10(4):407–415CrossRef Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10(4):407–415CrossRef
16.
go back to reference 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(5):541–546 (Epub 2007 Apr 2. Review)CrossRef 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(5):541–546 (Epub 2007 Apr 2. Review)CrossRef
17.
go back to reference Joint Task Force of the EFNS and the PNS. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies (2010) Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society–first revision. J Peripher Nerv Syst 15(3):185–195. https://doi.org/10.1111/j.1529-8027.2010.00278.x CrossRef Joint Task Force of the EFNS and the PNS. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies (2010) Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society–first revision. J Peripher Nerv Syst 15(3):185–195. https://​doi.​org/​10.​1111/​j.​1529-8027.​2010.​00278.​x CrossRef
18.
go back to reference ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111-117 (No abstract available. Erratum in: Am J Respir Crit Care Med. 2016 May 15;193(10):1185) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111-117 (No abstract available. Erratum in: Am J Respir Crit Care Med. 2016 May 15;193(10):1185)
20.
go back to reference Merkies IS, van Nes SI, Hanna K, Hughes RA, Deng C (2010) Confirming the efficacy of intravenous immunoglobulin in CIDP through minimum clinically important differences: shifting from statistical significance to clinical relevance. J Neurol Neurosurg Psychiatry 81(11):1194–1199. https://doi.org/10.1136/jnnp.2009.194324 (Epub 2010 Jul 20)CrossRefPubMed Merkies IS, van Nes SI, Hanna K, Hughes RA, Deng C (2010) Confirming the efficacy of intravenous immunoglobulin in CIDP through minimum clinically important differences: shifting from statistical significance to clinical relevance. J Neurol Neurosurg Psychiatry 81(11):1194–1199. https://​doi.​org/​10.​1136/​jnnp.​2009.​194324 (Epub 2010 Jul 20)CrossRefPubMed
24.
go back to reference Goldman MD, Marrie RA, Cohen JA (2008) Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler 14(3):383–390 (Epub 2007 Oct 17) Goldman MD, Marrie RA, Cohen JA (2008) Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler 14(3):383–390 (Epub 2007 Oct 17)
Metadata
Title
Six-minute walk test is reliable and sensitive in detecting response to therapy in CIDP
Authors
Emanuele Spina
Antonietta Topa
Rosa Iodice
Stefano Tozza
Lucia Ruggiero
Raffaele Dubbioso
Marcello Esposito
Pasquale Dolce
Lucio Santoro
Fiore Manganelli
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Keyword
Fatigue
Published in
Journal of Neurology / Issue 4/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-019-09207-1

Other articles of this Issue 4/2019

Journal of Neurology 4/2019 Go to the issue