Walking And Moving Around - Myocardial Infarction

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Outpatient Therapy

200-Meter Fast Walk Test:
•Title of the Instrument - 200-Meter Fast Walk Test
•Link to the Instrument - Not available
•Purpose of the Tool - To assess functional exercise capacity and mobility by walking as fast as possible for 200 meters.
•Descriptive Information - The patient walks 200 meters as fast as possible, on a level surface. Running is not allowed, but the subject can decrease the speed or stop to rest when needed. Time to complete the 200 meter distance is measured and recorded in seconds.
•ICF Domain - Activity limitations
•Time to Administer - Time it takes to complete the desired distance; less than 5 minutes
•Number of Items on the Tool - Not applicable
•Equipment Required - Stop watch; Measuring wheel to accurately measure distance prior to administering the test.
•Training Required - None needed
•Associated Costs - Free
•Population Tested - Coronary artery disease (acute coronary syndrome, specifically myocardial infarction), patients attending cardiac rehabilitation
•Minimal Detectable Change (MDC) - Not established
•Minimal Clinically Important Difference (MCID) - Not yet established. Gremeaux et al. found that the anchor-based method to calculate MCID did not reveal any significant difference between those who improved and those who did not improve.1 They determined that the distribution-based method showed that a 4.2 second improvement in scores represented the MCID. However, the authors of this study explain that there was no specified time improvement in which patients could identify a clinical change. Therefore, the MCID for the 200-meter walk test could not be determined.
•Cut-off Scores - Not established
•Criterion Validity - Not established
•Construct Validity - Strong correlation with the 36-Item Short-Form Health Questionnaire (SF-36), the physical component summary (r = -0.77, p < 0.01).2 Moderate correlation with the 6-Minute Walk Test (r = -0.566, p < 0.01).2
•Floor/Ceiling Effects - Not established
•Additional Considerations - The 200-meter walk test lends itself to performance at higher exercise intensities.3 The subjects included in the various studies were low risk coronary artery disease patients, recently suffered from an acute coronary syndrome, and had been referred to cardiac rehabilitation.1-3 Due to the higher exercise intensity, results cannot be generalized to the entire coronary artery disease population, and is only valid and reliable for low risk patients.2

200-Meter Fast Walk Test vs. 6-Minute Walk Test:
The 200-meter fast walk test is performed at higher exercise intensities than the 6-MWT.3 Patients who are deconditioned and two weeks post-MI, may be able to ambulate and get around in the community, but most likely would have limited aerobic capacities. Due to this characteristic, and the intensity required to perform the 200-meter walk test, it may not be the safest measure of functional capacity for the aforementioned patient population. Additionally, since we are measuring a patient’s ability to walk and move around, performing high intensity exercise as in the 200-meter test may not be all that functional. Gremeaux et al. suggest that the 6-MWT is more closely related to performing daily activities as compared to the 200-meter test.1 This is because of the intensity needed to perform most daily activities. Since we are assessing functional capacity and mobility, it makes sense to utilize a test that correlates with the intensity of activity an individual will need throughout the day. Moreover, if patients are not performing higher intensity activities daily, a change in their scores may not be captured using the 200-meter fast walk test. Therefore, the 6MWT is the best tool for assessing walking and moving around in patients two weeks post-MI attending outpatient physical therapy.

1. Gremeaux V, Troisgros O, Benaim S, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. 2011;92(4):611-619. doi: 10.1016/j.apmr.2010.11.023; 10.1016/j.apmr.2010.11.023.

2. Gremeaux V, Hannequin A, Laroche D, Deley G, Duclay J, Casillas JM. Reproducibility, validity and responsiveness of the 200-metre fast walk test in patients undergoing cardiac rehabilitation. Clin Rehabil. 2012;26(8):733-740. doi: 10.1177/0269215511427750; 10.1177/0269215511427750.

3. Gremeaux V, Deley G, Duclay J, Antoine D, Hannequin A, Casillas JM. The 200-m fast-walk test compared with the 6-min walk test and the maximal cardiopulmonary test: A pilot study. Am J Phys Med Rehabil. 2009;88(7):571-578. doi: 10.1097/PHM.0b013e3181aa416b; 10.1097/PHM.0b013e3181aa416b.

Amanda Schram, SPT

Emily Fincher, SPT

Six-Minute Walk Test

The Six-Minute Walk Test (6MWT) is an outcome measure used to assess functional mobility as well as aerobic capacity and endurance at a submaximal level. 1 This 6MWT has been widely used in a variety of populations, including patients with cardiopulmonary disorders, patients with neurological disorders, older adults, and pediatric patients. 2-5 When assessing functional mobility in patients who are two weeks status-post myocardial infarction (MI), the 6MWT is a reliable and safe outcome measurement tool that can be used. 6 The 6MWT is an excellent tool because it is inexpensive and easy to administer.  It requires minimal equipment (stop watch and a tool to measure distance) and only six minutes to complete.  Additionally, the 6MWT is easily reproduced, allowing improvements in distance walked over time to be captured. 1 Gremeaux et al.7 reported that in patients with coronary artery disease (CAD) who experienced an acute coronary syndrome (myocardial infarction and/or unstable angina), the minimally clinically important difference (MCID) was 25 meters. More information about the 6MWT can be found on the rehab measures website.

Skilled Nursing Facility

Two Minute Walk Test

Alison Doyle,SPT

One functional outcome measure a patient in a SNF two weeks post MI could take is the two minute walk test. http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=896 The test consists of having the patient walk as far as they can while the administrator measures the distance that is achieved after two minutes. It is a simple test that can show a patient’s baseline and progress through distance at the end of two minutes. The patient should walk as fast as possible and the use of an assistive device is allowed but use must be consistent every time the test is measured. It has been shown to be valid and reliable as a measure in walking in older adults which are a large portion of the SNF population. It has also been shown to be valid and reliable as a measure in walking in cardiac surgery patients who are also de-conditioned due to damage of the heart muscle. The six minute walk test is another commonly used test to measure functional outcomes. This test is exactly the same as the two minute walk test but lasts four minutes longer. A patient who is currently residing in a SNF could potentially have less walking endurance than a patient who has been discharged home. Therefore, the two minute walk test could be considered to be a more appropriate test than the six minute walk test for a patient who is two weeks post MI in a SNF because it is less stressful on the heart. A great way to make the TMWT better would be to ask the patient’s rate of perceived exertion. It could help give the physical therapist an idea of how difficult it was for the patient. This is especially true if they are on a beta blocker medication which makes measuring pulse rate more difficult.

Home Care Setting

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