Browsing by Author "Fell, Brittany L."

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    Assessment of functional capacity in low-resource settings – adapted six-minute walk tests
    (Stellenbosch : Stellenbosch University, 2021-03) Fell, Brittany L.; Heine, Martin, 1957-; Hanekom, Susan D.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Measuring functional capacity is an important assessment tool that aids researchers and clinicians in determining the diagnosis, prognosis, and management of patients in various populations. The gold standard for functional capacity testing is cardiopulmonary exercise testing. However, this test requires specialised equipment and trained staff, and is therefore not readily available in many clinical settings. The 6-minute walk test (6MWT) is used as a validated alternative, requiring minimal resources or training. In 2002 the American Thoracic Society (ATS) published guidelines to standardise the implementation of the test. However, considering several constraints, especially within the context of ow-resource settings (LRS) researchers and clinicians alike have had to adapt the methods used when implementing the test. Using different methods for the same test may limit the interpretation and clinical applications of the test. The aim of this theses is to evaluate the application and protocols used for the 6-minute walk test within LRS. Methods: A scoping review was undertaken to identify published studies that implement adapted protocols when conducting the 6MWT. Additionally, the rationale for these adaptations were investigated. Five electronic databases were accessed and searched from inception to October 2019. Data concerning the study source, participants, reported 6MWT purpose, variations (e.g. course length), 6MWT outcome, and rationale for making protocol adaptations were extracted. The findings in this study were used to inform the development of a cross-sectional study with the aim to determine the agreement between the ATS standard 30m 6MWT pathway, a 10m straight and a 10m figure-ofeight pathway, in patients with non-communicable disease. Results: The search returned 564 records of which 22 studies were included. Studies were predominantly conducted in lower-middle income countries. The most common adaptation made to ATS guidelines was course length, being either shorter or longer than the standard 30 meters. Few studies (n = 8, 36%) provided a rationale for adapting the 6MWT. However, based on these eight studies, space limitations was the most common argument for making adaptations. Subsequently, we recruited 27 patients with one or more non-communicable disease to perform two 6MWTs. Fifteen participants performed both a 30 meter straight and a 10m straight 6MWT and twelve participants performed a 30m straight and a 10mfigure-of-eight 6MWT. Regardless of chosen configuration (10m figure-of-eight versus 10m straight), a shortened 6MWT pathway resulted in a significantly smaller 6-minute walk distance. Moreover, the difference was larger than the reported minimal clinically important difference thereby highlighting the clinical implications of adapting the 6MWT. Conclusion: Strict adherence to the ATS guidelines for conducting the 6MWT is challenging. Common adaptations included a change in course length and/or course configuration (chapter 2), with such adaptations having clinically relevant implications to the outcome of the 6WMT (chapter 3). This provides limitations to the application and interpretation of the test. Researchers and clinicians need to take this into consideration when adapting the protocol used for the 6MWT. Reference equations that take into account the adaptations should be considered. However, accounting for every variation of the test may not be feasible. Alternative tests for functional capacity testing within the context of LRS may be a more practical solution.