Validation of Stroke-Specific Protocols to Enhance the ...

Validation of Stroke-Specific Protocols to Enhance the Clinical Utility of the 10-Metre and 6-Minute Walk Tests

in People with Acute, Subacute, and Chronic Stroke

by

Darren Kai-Young Cheng

A thesis submitted in conformity with the requirements for the degree of Master of Science Rehabilitation Sciences Institute University of Toronto

? Copyright by Darren Cheng 2018

Validation of Stroke-Specific Protocols to Enhance the Clinical Utility of the 10-Metre and 6-Minute Walk Tests

in People with Acute, Subacute, and Chronic stroke

Abstract

Darren Cheng Master of Science

Rehabilitation Sciences Institute University of Toronto

2018

Background: Standardized stroke-specific 10-metre walk test (10mWT) and 6-minute walk test (6MWT) protocols have been developed, but reliability, measurement error, and validity have yet to be evaluated. Objectives: To estimate the 1) test-retest reliability, 2) measurement error, and 3) construct validity of stroke-specific protocols for the 10mWT and 6MWT using 15 and 30-metre walkway lengths in people post-stroke. Methods: A quantitative, cross-sectional study was conducted. Results: 17 individuals participated. Two evaluations, 2-3 days apart, were completed. Estimates of test-retest reliability for all tests were high (ICC2, 1=0.75-0.97). Minimal detectable change (MDC95) values were similar to the literature for the 6MWT, but larger for the 10mWT. Correlations were high between walk tests (r=0.70-0.93, p0.05). Conclusions: The 10mWT, and 6MWT on both 15-metre and 30-metre walkways, are reliable, while validity was partially supported.

Keywords: Stroke; Walk test; Gait speed; Walking capacity; Reliability; Measurement error; Validity

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Acknowledgments

First, I would like to extend my utmost appreciation to my thesis supervisor, Dr. Nancy Salbach. You have provided me with nothing but constant support and guidance throughout my degree and pushed me to grow as a student, scientist, and person. I have been incredibly fortunate and grateful to have had you as a mentor. To my Supervisory Committee, I would like to thank Dr. Michelle Nelson and Dr. Dina Brooks for the enthusiasm, expertise, support, and insightful feedback you have both provided over the past two years.

I would like to thank my peers and lab mates for your encouragement and guidance. To my friends and family, especially those from the Victoria University Don Team, thank you for your continual love and support. I would like to thank the physical therapists and hospital administrators who took time out of their busy schedules to assist with the study. Thank you in particular to Carina Orschel, Heather Kwok, Sheila Furness, and Paula Shing from BridgepointSinai Health System, and Shannon Reid and Elizabeth Udler from West Park Healthcare Centre, who were instrumental in the conduct of this study. Finally, I would like to thank the patients for your time, energy, and optimism ? this work would not be possible without you.

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Table of Contents

Acknowledgments.......................................................................................................................... iii Table of Contents ........................................................................................................................... iv List of Tables ................................................................................................................................. vi List of Figures ............................................................................................................................... vii List of Abbreviations ................................................................................................................... viii List of Appendices ......................................................................................................................... ix Chapter 1 Introduction .................................................................................................................... 1

Introduction ................................................................................................................................ 2 Chapter 2 Literature Review ........................................................................................................... 5

Literature Review....................................................................................................................... 6 2.1 The Epidemiology of Stroke ............................................................................................... 6 2.2 The Impact of Stroke .......................................................................................................... 6 2.3 Post-stroke Rehabilitation in Canada.................................................................................. 8 2.4 Standardized assessment tools and use in clinical practice ................................................ 9 2.5 The 10-metre walk test and 6-minute walk test ................................................................ 10 2.6 Rationale ........................................................................................................................... 15 Chapter 3 Validation of stroke-specific protocols to enhance the clinical utility of the 10metre walk test and 6-minute walk tests in people with acute, subacute, and chronic stroke . 19 Validation of stroke-specific protocols to enhance the clinical utility of the 10-metre and 6-minute walk tests in people with acute, subacute, and chronic stroke.................................. 20 3.1 Introduction....................................................................................................................... 21 3.2 Methods............................................................................................................................. 24 3.3 Results............................................................................................................................... 28 3.4 Discussion ......................................................................................................................... 30 3.5 Conclusion ........................................................................................................................ 34 Chapter 4 Summary and Conclusion ............................................................................................ 40

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Summary and Conclusion ........................................................................................................ 41 4.1 Summary and Conclusion ................................................................................................. 41 4.2 Future Research ................................................................................................................ 44 References..................................................................................................................................... 45 Appendices.................................................................................................................................... 56

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List of Tables

Table 2.1 Test-retest reliability and measurement error of the 10mWT and similar gait speed tests Table 2.2 Test-retest reliability and measurement error of the 6MWT Table 2.3 Construct validity ? correlations between 10mWT with 6MWT Table 2.4 Construct validity ? correlations between 10mWT and dynamometer strength Table 3.1 Sociodemographic and Clinical Characteristics (n=17) Table 3.2 Performance, test-retest reliability, and measurement error (n=16) Table 3.3 Construct validity (n=17)

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List of Figures

Figure 3.1 Bland-Altman Plots for the a. 10mWT, b. 6MWT15m, and c. 6MWT30m (n=16)

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List of Abbreviations

10mWT: 10-metre Walk Test 6MWT: 6-minute Walk Test ADL: Activities of daily living BP: Blood Pressure CI: Confidence Interval CMSA: Chedoke-McMaster Stroke Assessment COSMIN: Consensus-based Standards for the Selection of Health Measurement Instruments ERS/ATS: European Respiratory Society/American Thoracic Society FIM: Functional independence measure HR: Heart Rate HRQL: Health-related quality of life ICC: Intraclass Correlation Coefficient ICF: International Classification of Functioning, Disability and Health MDC: Minimal Detectable Change PT: Physical Therapist RPE: Rating of Perceived Exertion SEM: Standard Error of Measurement SIS: Stroke Impact Scale

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