Article Text


Pulmonary rehabilitation
P42 Comparison of a 1- and 2-walk protocol for the endurance shuttle walk test when measuring change due to therapeutic intervention in COPD patients
  1. SE Roberts1,
  2. M Stern1,
  3. FM Schreuder2,
  4. T Watson2
  1. 1The Whittington Hospital NHS Trust, London, UK
  2. 2University of Hertfordshire, Hatfield, UK


Introduction The endurance shuttle walk test (ESWT) is an externally paced field endurance walking test. To perform the ESWT requires two incremental shuttle walk tests (ISWTs) to determine the walk speed for the ESWT, a practise ESWT (pESWT) and a repeat ESWT. The minimum important clinical difference (MCID) has been reported as 68%.1 Limits of agreement between ESWT carried out with and without a practise walk on the same day have been shown to be ±100 s2 and it is proposed the practise walk may not be needed. Completing the standard ESWT protocol presents a considerable burden to patients and clinicians alike; being able to drop the practise walk would be of benefit. This study investigated the need for a pESWT when measuring change after 8 weeks.

Method A retrospective analysis of the data collected from ESWTs performed as part of another study was carried out. A 2-walk and a 1-walk protocol were defined. Both protocols required 2 ISWTs; the 2-walk protocol used 2 ESWTs, the longest taken as the outcome, the 1-walk protocol used the first walk as the outcome. Completion rates, floor and ceiling effects, same-day limits of agreement, and limits of agreement for change over 8 weeks were calculated for the protocols.

Results 41 COPD patients (26 male) were recruited; mean (SD) age 68(11) years, FEV1% predicted 47(15.80)%. Results of comparison of protocols are given in Abstract P42 Table 1. At 80%, the limits of agreement for the protocols was less than the 92% change expected from pulmonary rehabilitation3 and less than that described2 as ‘somewhat better’ (113%) but greater than the MCID of 68%.2 The 1-walk protocol had superior completion but higher ceiling rates.

Abstract P42 Table 1

Results of comparison between two ESWT protocols

Conclusion The data presented here suggests that, in clinical practice when measuring change related to an exercise intervention, only one ESWT is required. For research purposes, particularly for non-exercise interventions, the standard protocol should be retained as it is more likely to identify marginal difference and demonstrates less of a ceiling effect.

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