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Reliability measures of the 6-minute walking test smartphone application (6WT app)
EANS Academy. Stienen M. 09/25/19; 275364; EP12005
Dr. Martin Stienen
Dr. Martin Stienen

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Abstract
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Background: Measures of objective functional impairment (OFI) are increasingly applied in patient care and research. The 6-minute walking test (6WT) determines restrictions in the walking distance (6WD; in m) in patients with lumbar spinal stenosis (LSS) and other spinal disorders. The traditional 6WT is cumbersome to apply, however, as specialized in-hospital infrastructure and personal is required.
Methods: We designed a free smartphone app (iOS & Android) that allows patients to measure the 6WD in their home environment using global positioning system (GPS) coordinates. We here compared app-based 6WD measurements with a gold standard (TR Industrial 88016 FX distance wheel (DW)). Measurements were obtained over a range of smartphone models, testing environments, walking patterns and speed. The main outcome was relative measurement error (ME; in % of 6WD). The intraclass correlation coefficient (ICC) for agreement between app- or DW-based 6WD measurements was calculated.
Results: A total of n=375 measurements were obtained and measurement accuracy was given with all smartphone types tested, in the neighborhood, nature side environment and city environment (without higher buildings), with unspecified or straight walking course, continuous or stop-and-go walking pattern (|relative ME|< 7.5%). Under these circumstances, the ICC for 6WD was 0.98 (95% CI 0.98 - 0.99; p< 0.001). Measurements were inaccurate indoors, in city areas with high-rises, as well as with walking courses with a predominantly rectangular course. Walking speed had an influence on the ME, with an increase in relative ME by 2.0% with every km/h walked slower (95%CI 1.4-2.6%, p< 0.001). Mathematical post-hoc adjustment of app-based 6WD for velocity-dependent error mitigated the relative ME (p< 0.012) and attenuated velocity-dependent ME (p=0.336).
Conclusions: We developed a free smartphone app that measures the 6WD conveniently using GPS coordinates. The app empowers patient to accurately self-measure OFI over time, e.g. before and after surgical treatment.
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