6 Minute Walk Test

Last Updated

August 23, 2021

Purpose

This is a 1-item objective measure designed to assess submaximal aerobic/functional walking capacity, community walking prediction, and serve as a predictor of morbidity and mortality in cardiac patients.

Link to Instrument

Instrument Details

Acronym 6MWT

Area of Assessment

Aerobic Capacity
Gait
Life Participation
Functional Mobility

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Equipment costs

Diagnosis/Conditions

Arthritis + Joint Conditions
Multiple Sclerosis
Pain Management
Parkinson's Disease & Movement Disorders
Spinal Cord Injury
Stroke Recovery

Stroke

Spinal Injuries

Pulmonary Diseases

Parkinson's Disease

Osteoarthritis

Older Adults and Geriatric Care

Multiple Sclerosis

Alzheimer's Disease and Progressive Dementia

Mixed Populations

Brain Injury

Arthritis

The score of the test is the distance a patient walks in 6 minutes.
Walking is self-paced on a standardized walk space using standardized instructions.
The patient may take as many standing rests as they like, but the timer should kept running and the number of rests taken and the total rest time recorded.
Assistive devices are allowed and must be documented.
Clinician assistance is permitted and must be from posterior so as not to pace the participant, and the level of assist must be documented.
When administering the test, do not walk in front of or directly beside the patient, as this may “pace” the patient and influence the speed and distance they walk. Instead, walk at least a half step behind the patient.
If a participant cannot walk but has goals and expectations to regain walking, a 6MWT score of 0 should be documented.
No talking should be done with the participant during the test other than the scripted and timed feedback outlined in the 6MWT guidelines.

Number of Items

Stop watch
Standard chair
2-pieces of colored tape
2-orange cones
Measuring wheel to measure distance of walkway and 3-meter increments (recommended)
Floor markers at every 3-meters of walkway space
Walkway with level surface (12, 14, or 34 meters)
Borg RPE scale
Sphygmomanometer
Stethoscope

Less than 10 minutes

Participants: 6 minutes (plus 10 minutes seated immediately prior to test if needed)
Clinicians: 10 minutes (6-minutes test administration time and an estimated 4 added minutes for set up and break-down of the test materials and environment.

Required Training

No Training

Required Training Description

No training required, but it is recommended that 6MWT administrators review and be trained in following the ATS guidelines for the 6MWT.

Preschool Child

2 - 5

years

Child

6 - 12

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS and Rachel Tappan PT, NCS in 2010; Updated with references for the SCI and PD populations by Lars Petersen, SPT and Shawn White, SPT in 2011; Updated by Candy Tefertiller PT, DPT, ATP, NCS and Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references for the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA; Updated with references for Osteoarthritis, Stroke, and Alzheimer's Disease by Kevin Pelczarski, SPT, Melissa Potts, SPT, and Brittany Brown, SPT in 10/2012; Updated with references for the PD population by Jeffrey Hoder, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013. Updated for the Stroke population by Julie Schwertfeger, PhD and Jane E. Sullivan, PT, DHS in 8/2021. Updated for the Multiple Sclerosis population by Kevin Fearn, MS, Shirley Ryan AbilityLab in 10/2024.

Body Part

Lower Extremity
Back

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

American Physical Therapy Association Academies: Geriatrics, Neurology, Oncologic, and Pediatric

The American Rheumatology Association

American Thoracic Society

Recommendations for use of the instrument from the Neurology Academy of the American Physical Therapy Association's Multiple Sclerosis Taskforce (MSEDGE), Parkinson's Taskforce (PD EDGE), Spinal Cord Injury Taskforce (SCI Edge), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
LS / UR	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular < 6 months weeks post)

SCI EDGE

StrokEDGE

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

	I	II	III	IV	V
PD EDGE	HR	HR	HR	HR	NR

Recommendations based on level of care in which the assessment is taken:

	Acute Care	Inpatient Rehabilitation	Skilled Nursing Facility	Outpatient Rehabilitation	Home Health
MS EDGE	R	HR	R	HR	NR
StrokEDGE	HR	HR	HR	HR	HR
TBI EDGE	LS	R	LS	R	NR

Recommendations based on SCI AIS Classification:

	AIS A/B	AIS C/D
SCI EDGE	LS	HR

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	HR	R	LS	NR

Recommendations based on EDSS Classification:

	EDSS 0.0 – 3.5	EDSS 4.0 – 5.5	EDSS 6.0 – 7.5	EDSS 8.0 – 9.5
MS EDGE	HR	HR	R	NR

Recommendations for entry-level physical therapy education and use in research:

Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
MS EDGE	Yes	Yes	Yes	No
PD EDGE	Yes	Yes	Yes	Not reported
SCI EDGE	Yes	Yes	Yes	Not reported
StrokEDGE	Yes	Yes	Yes	Not reported
TBI EDGE	Yes	Yes	Yes	Not reported

Considerations

Reference Equations:

6MWD: (Enright et al., 1998; n = 290 healthy adults 40-80yo)

Gender-specific regression equations explained 40% of the variance in the distance walked in healthy adults:
Men: 6MWD = (7.57 X height cm) – (5.02 X age) – (1.76 x weight kg) -309
Women: 6MWD = (2.11 x height cm) – (2.29 x weight kg) – (5.78 x age) + 667m

Considerations:

There are variations in walkway length used across studies that range from a 12, 14, 30, or 34-meter (12-meter ANPT Core Measure guidelines or 30-meter ATS guidelines) test walkway with 2 meters excess at each end to allow turning room.

The 6MWT demonstrated significant differences depending on the length of track used. Asking participants to walk on a 10 meter track where participants were asked to walk back and forth resulted in shorter distances than when asked to walk on a 10 by 50 meter indoor track (Scivoletto et al., 2011). Therefore, it is important to standardize the track for both clinical and research purposes.

Absolute and relative contraindication and precautions should be reviewed and considered prior to administering the 6MWT. The American Thoracic Society guidelines for the Six-Minute Walk Test recommend use of a 30 meter or 100 foot walkway with the length of the corridor marked every 3 meters. Turnaround points are to be marked by a cone (ATS, 2002, https://www.thoracic.org/statements/resources/pfet/sixminute.pdf).

Less affected limb more important than affected limb in explaining variance in walking capacity using 6MWD in chronic incomplete spinal cord injury (Kim et al., 2004)

Contraindications are unstable angina and MI in the last month since testing (Rasekaba et al., 2004).

Outdoor testing of the 6MWT in participants with stoke can be performed with consideration of the SEM scores. Using a GPS provides similar results as a measuring wheel and may be more convenient while freeing up the hands of the therapist to assist the participant. Testing outdoors over level ground free of street crossings allows for testing in the participants’ own neighborhood after discharge from an impatient facility.

Alzheimer’s Disease: (Tappen et al., 1997) Individuals with moderate to severe Alzheimer’s disease may have impaired balance and require physical assistance to ambulate. Some individuals may also require the use of an assistive device to walk. Examiners may need to use physical and verbal cues during the testing period because patients with Alzheimer’s disease may become distracted or have difficulty understanding directions.

Translated 6MWT:

Spanish:
https://www.medigraphic.com/pdfs/neumo/nt-2015/nt152h.pdf

Italian:
http://www.geird.org/protocolli_misura/6-mwt_worksheet_it_vr.pdf

Swedish:
http://www.akademiska.se/Global/Neuro/Sjukgymnastik/Dokument/Behandlingsriktlinjer/NAtionella%20riktlinjer/Riktlinjer%206%20minuters%20g%C3%A5n

Chinese (simplified):
http://www.clinicmed.net/journal/fulltext/volume/1/issue/4/article/410

Japanese:
http://sugp.wakasato.jp/Material/Medicine/cai/text/subject02/no8/html/section17.html

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database (RMD). Shirely Ryan AbilityLab (formerly RIC) is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at RehabMeasures@sralab.org.

Do you see an error or have a suggestion for this instrument summary? Please email us!

Standard Error of Measurement (SEM)

Alzheimer’s Disease:

(Ries et al, 2009; n = 20; mean age = 81.05 (9.48) years; mild to moderate AD; n = 31; mean age = 80.48 (8.43); moderately severe to severe AD, Alzheimer’s Disease)

SEM for mild to moderate AD = 21.86 meters
SEM for moderately severe to severe AD = 19.57 meters

Minimal Detectable Change (MDC)

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer’s Disease)

MDC = 33.47 meters

Normative Data

Alzheimer's Disease:

(Tappen et al, 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)

Mean Mini-Mental State Exam Score = 9.3 (6.0)
Mean Length of Stay: 822

Test/Retest Reliability

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer’s disease)

Excellent test-retest reliability for all participants (ICC = 0.982-0.987)

Interrater/Intrarater Reliability

Alzheimer’s Disease:

(Tappen et al. 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)

Excellent interrater reliability (ICC = 0.97 - 0.99)
Excellent intrarater reliability (ICC = 0.76 - 0.9)

Standard Error of Measurement (SEM)

Geriatrics and Stroke:

(Perera et al, 2006; Strength training trial: n = 100 older adults with mobility disabilities; mean age = 77.6 (7.6) years; Intervention trial: n =100 geriatrics w/ mild to moderate mobility limitations and stroke; mean time since stroke onset 76 (28) days; mean age = 69.8 (10.3) years, Geriatrics and Stroke)

SEM for strenth training trial = 21 meters
SEM for interventional trial = 22 meters

Minimal Detectable Change (MDC)

Geriatrics:

(Perera et al, 2006, Geriatrics)

MDC (calculated from SEM) = 58.21 meters (190.98 feet)

Minimally Clinically Important Difference (MCID)

Geriatrics and Stroke:

(Perera et al, 2006, Geriatrics and Stroke)

MCID = 50 meters

Normative Data

Community-dwelling Elderly:

(Steffen et al, 2002; n = 96; community dwelling elderly people with independent function who were nonsmokers with no history of dizziness; > 60 yo and did not use assistive devices, Community-dwelling Elderly)

Mean Distance in Meters by Age & Gender
Age	Male	Female
60-69 yrs	572 m	538 m
70-79 yrs	527 m	471 m
80-89 yrs	417 m	392 m

Test/Retest Reliability

Geriatrics:

(Harada et al, 1999; n = 86; mean age = 75 (6) years, Geriatrics)

Excellent test-retest reliability (r = 0.95)

(Steffen et al, 2002, Geriatrics)

Excellent test-retest reliability (ICC = 0.95)

Criterion Validity (Predictive/Concurrent)

Elderly:

(Harada et al, 1999; n = 86 older adults without significant disease; 35 were recruited from retirement homes and 57 from community centers; mean age = 75 (6) years, Elderly)

Adequate concurrent validity with:
- Chair stands (r = 0.67)
- Standing balance (r = 0.52)
- Gait speed (r = -0.73)

*Distance walked was greater in active older healthy adults than in inactive older healthy adults (p < 0.0001)

Construct Validity

Geriatrics:

(Harada et al, 1999, Geriatrics)

Adequate correlation with chair stands (r = 0.67), tandem balance (r = 0.52), and gait speed (r = -0.73)
Adequate correlation with SF 36 physical function subscale (r = 0.55) and general health perceptions subscale (r = 0.39)
Poor correlation with BMI (r = -0.07)

Responsiveness

Geriatrics:

(Perera et al, 2006, Geriatrics)

Small meaningful change 20 m
Substantial meaningful change 50 m

Standard Error of Measurement (SEM)

Osteoarthritis:

(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)

SEM = 26.29 meters

Minimal Detectable Change (MDC)

Osteoarthritis:

(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)

MDC = 61.34 meters

Test/Retest Reliability

Osteoarthritis:

(Kennedy et al, 2005, Osteoarthritis)

Excellent test-retest reliability (ICC = 0.94)

Minimal Detectable Change (MDC)

Parkinsonism:

(Steffen and Seney, 2008; n = 37 community-dwelling older adults with Parkinsonism, mean age = 71 (12) years; mean Hoehn & Yahr Stage of 2, Parkinsonism)

MDC = 82 meters (269 feet)

Test/Retest Reliability

Parkinson's Disease:

(Steffen et al, 2008)

Excellent test retest reliability (ICC = 0.95 - 0.96)

Standard Error of Measurement (SEM)

SCI:

(van Hedel et al, 2005; n = 22 SCI patients assessed within the first month injury and reassessed at 3, 6, and 12 months; mean age = 45.5 (16.7) years; WISCI II score > 0; quoted from Lam et al; 2008, Acure SCI)

SEM = 16.5 meters (54 feet)

(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)

SEM = 16.5 meters (54.13 feet)

Minimal Detectable Change (MDC)

SCI:

(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)

MDC = 45.8 meters (150 feet) or a 22% change

Minimally Clinically Important Difference (MCID)

Spinal Cord Injury:

(Forrrest et al, 2014; n = 249 patients enrolled in standardized Locomotor Training therapy programs that were admitted between February 2008 and April 2011; patients were evaulated at 7 out-patient clinical sites; mean age = 42 (16) years; AIS C = 20, D = 179, Not Evaluated = 50; mean time since SCI = 0.7 years)

Overall MCID = 0.10 m/s
Slow MCID = 0.11 m/s
Fast MCID = N/A: among fast walkers, the 6MWT did not significantly correspond with clinically relevant change and reliable MCID could not be calculated

Normative Data

SCI:

(Barbeau et al, 2007; n = 107, ASIA-C and D; n = 38, ASIA-B; with lesions between C-5 and L-3, tested at 3, 6 and 12 months post-injury, Acute SCI)

No significant difference between 15.2 m and 6 minute walking tests at 3 and 6 months; however, gait speed was significantly faster during the shorter distance test at the 12 month follow-up.

Comparison of Walking Speed Within Subjects With Upper Motor Neuron Lesions During the Spinal Cord Injury Locomotor Trial (SCILT)

Months after entry to trial	n	Walking Speed (m/s) over 15.2 m	Walking Speed (m/s) over 6 minutes	p value
3	66	0.72 (0.05)	0.64 (0.06)	0.14
6	69	0.92 (0.06)	0.79 (0.05)	0.29
12	70	1.08 (0.06)	0.88 (0.06)	0.001

Comparison of Walking Speed by the slowest, middle and fastest patients in each data collection at end of therapy: 3 months
Variable	n	Quartile	Walking Speed (m/s) over 15.2 m	p value
15.2 m 6 minute	14	Lower	0.02 (0.06) 0.16 (0.06)	0.15
15.2 m 6 minute	33	Middle	0.74 (0.05) 0.62 (0.29)	0.07
15.2 m 6 minute	19	Upper	1.55 (0.06) 1.33 (0.41)	0.01

**No statistical difference noted in gait speed between the two measures for the lower and middle quartile subject when stratified by walking speed; However, a statistical difference was found for individuals who achieved community walking speeds (> 0.8 m/s - 1.0 m/s) in the 15.2 m walking test upon completion of the 3 month treatment intervention as well as 12 month follow up.

(Olmos et al, 2008; n = 18; all participants were AIS D; tested three times each with a 60 minute interval between test run, in a Physical Therapy gym versus in a community environment, Chronic SCI)

Statistically significant improvement found when individuals completed 6MWT in community environment vs. physical therapy gym (p < 0.01)

Six-Minute Walking Test (m)
	6MWT Gym	6MWT Community
Mean	382.39	401.44
Median	371.75	367.80
SD	120.988	130.276
Min	151	151
Max	560	584

Interrater/Intrarater Reliability

SCI:

(Scivoletto et al, 2011; n = 37; median age = 58.5 (range 19–77) years; median time from onset = 24 (range 6–109) months; AIS D = 35, C = 2; Median; WISCI = 16, Chronic SCI)

Excellent Inter-rater reliability (ICC = 0.99)
Excellent Intra-rater reliability (ICC = 0.99)

(van Hedel et al, 2005; n = 22; AIS-A = 1, B = 0, C = 3, D = 18; mean age = 52 (20) years)

Tested on 3 occasions within 7 days:

Excellent inter-rater reliability (r = 0.97)

Determined by comparing the 2 measurements performed by a single therapist

Excellent intra-rater reliability (r = 0.98)
Bland Altman plot: Inter-rater reliability > intra-rater reliability and may indicate first test influence over second test

Criterion Validity (Predictive/Concurrent)

SCI:

(Lam et al, 2008, SCI)

Excellent concurrent validity with: 10 Meter Walk Test (r = -0.95)
Adequate concurrent validity with: Timed Up and Go (r = -0.88)
Poor concurrent validity with Walking Index for SCI II (r = 0.60)

(van Hedel et al, 2005; n = 75, mean age = 54 (20) years; AIS classifications C and D included, SCI)

Excellent concurrent validity with:
- Timed Up and Go (r = -0.88)
- 10 Meter Walk Test (r = -0.95)
Poor concurrent validity with
- Walking Index for SCI II in individuals with poor walking abilities (WISCI II 0-10) r = -0.22
Excellent concurrent validity with
- Walking Index for SCI II in individuals with better walking abilities (WISCI II 11-20) r = 0.64
Poor concurrent validity with:
- WISCI II (0-8, 10, 11, 14, 17), dependent walkers (n = 15) (r = 0.21)
Excellent concurrent validity with:
- WISCI II (9, 12, 13, 15, 16, 18-20), independent walkers (n = 45), (r = 0.65)

Construct Validity

SCI:

(van Hedel et al, 2007; longitudinal study looking at 6min and 10 MWT at 1, 3, and 6 mo post injury, incomplete SCI who were able to ambulate 10m within 3 months post SCI n = 51, 22 tetraplegic, 29 paraplegic. Cross sectional study n = 18 incomplete SCI, acute and chronic range 2wks to 8 years AIS-C or D, utilized middle 10m of 14m walk, Acute/Subacute SCI)

Walking speed differed at each time period (1, 3, 6 mo post) but did not differ between the tests
Regression analysis performed to look at relationship between the tests at preferred and maximum walking speed
- Preferred walking speed R2 = 0.87
- Maximum walking speed R2 = 0.86

(Musselman and Brunton, 2011; n = 32 individuals with incomplete SCI; sex = 24 males, 8 females; mean age = 47.6 (14.2) years, SCI)

Adequate correlation between the 6MWT and Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) (r = -0.59)

(van Hedel et al, 2006, n = 22, incomplete SCI who could ambulate within the 1^st month post SCI, measured at 1 mo, 3 mo, 6 mo, and 12 mo post, middle 10 m of 14 m walk used, Acute to chronic incomplete SCI)

	LEMS	WISCI II	10MWT
Within 1 Month
6MWT	Adequate r = 0.54**	Excellent r = 0.78*	Excellent r = -0.91*
After 3 Months
6MWT	Adequate r = 0.34	Poor r = 0.28	Excellent r = -0.90*
After 6 Months
6MWT	Adequate r = 0.49***	Adequate r = 0.36	Excellent r = -0.87*
After 12 Months
6MWT	Adequate r = 0.55**	Adequate r = 0.36	Excellent r = -0.86*
p < 0.001 * p ≤ 0.01 *** p = 0.02 Spearman’s Correlations

Content Validity

SCI:

(Jackson et al, 2008; n = 54 expert raters asked to assess each measure in three categories: valid or useful, useful but requires validation or changes/improvements, not useful or valid for research in SCI, SCI)

Expert Evaluations:
Measure	Valid or Useful	Useful but requires validation	Not useful or valid for RESEARCH	Total Votes	Measure
10 Meter Walk Test	32 (60%)	20 (38%)	1 (2%)	53	10 Meter Walk Test
6 Minute Walk Test	19 (37%)	30 (58%)	3 (6%)	52	6 Minute Walk Test
FIM-L	3 (6%)	18 (36%)	29 (58%)	50	FIM-L
Votes (%)

(Scivolleto et al, 2011; n = 37 with mean time of onset 24 months; 32 AIS-D and 2 AIS-C; Assessed 6MWT using a short or long track, SCI)

Significant differences (39.1 m) noted between long and short tracks p < 0.001

Responsiveness

SCI:

(van Hedel et al, 2006, SCI)

For individuals with incomplete SCI, the 6MWT was able to detect walking capacity improvements in patients with less ambulatory impairment during the acute and subacute stages of recovery at 3 and 6 months post injury. Similar findings were not demonstrated with the WISCI II or LEMS.
Statistically significant responsiveness 1-3 months post injury and 3-6 months post injury with larger effect size noted 1-3 months post injury (found in Lam et al, 2008)
For individuals with incomplete SCI, the 6MWT was not able to detect walking capacity improvements between 6 and 12 months post injury.
- May be a result of this sample having reached normal walking speeds at 6 months post injury (1.39 m/s)

Further study with a larger sample size needs evaluate responsiveness for chronic (> 12 months ) injuries

Standard Error of Measurement (SEM)

Stroke:

(Eng et al, 2004; n = 12; mean age = 62.5 (8.6) years; mean time since stroke onset = 3.5 (2.0) years, moderate motor deficits, Chronic Stroke)

SEM = 12.4 meters (40.68 feet)

(Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years; mean time since stroke onset 16 (5) months for males; 18 (5) months for females, Chronic Stroke)

SEM = 18.6 meters (61 feet) or 4.8% change

(Wevers et al, 2011; n = 27 patients discharged home from an inpatient rehabilitation center after stroke, in the Functional Ambulation category; tested outdoors with both GPS and a measuring wheel; mean age = 60.7 (10.9) years; mean time since stroke onset = 266 (38) days, Chronic Stroke)

SEM = 11.9 meters for measuring wheel (outdoors)
SEM = 18.1 meters for GPS (outdoors)

Geriatrics and Stroke:

(Perera et al, 2006; Strength training trial: n = 100 older adults with mobility disabilities; mean age = 77.6 (7.6) years; Intervention trial: n = 100 geriatrics w/ mild to moderate mobility limitations and stroke; mean time since stroke onset 76 (28) days; mean age = 69.8 (10.3) years, Geriatrics and Stroke)

SEM for strength training trial = 21 meters
SEM for interventional trial = 22 meters

Minimal Detectable Change (MDC)

Stroke:

(Eng et al, 2004, Chronic Stroke)

MDC (Calculated from SEM) = 34.37 meters (112.76 feet)

(Flansbjer et al, 2005, Chronic Stroke)

MDC = 36.6 meters (120 feet) or a 13% change

(Perera et al, 2006, Subacute Stroke)

MDC (Calculated from SEM) = 60.98 meters (200.01 feet)

Minimally Clinically Important Difference (MCID)

Subacute Stroke:

(Fulk & He, 2018; n = 265 (people from the full data sample from the Locomotor Experience Applied Post-Stroke (LEAPS) trial); Mean Age of Early Locomotor Training Group = 85 (61.2) and Home Exercise Group = 65 (51.6) years)

MCID = 71 meters with the mRS as the anchor (entire sample) (AUC = 0.66)
MCID = 65 meters with the Stroke Impact Scale (SIS) as the anchor (entire sample) (AUC = 0.59)
MCID = 44 meters for participants with initial gait speed < 0.40 with the mRS as the anchor (AUC = 0.72)
MCID = 34 meters for participants with initial gait speed < 0.40 with SIS as the anchor (AUC = 0.62)
MCID = 71 meters for participants with initial gait speed ≥ 0.40 with mRS as the anchor (AUC = 0.59)
MCID = 130 meters for participants with initial gait speed ≥ 0.40 with the SIS as the anchor (AUC = 0.56)

(Tang, Eng, & Rand, 2012; n= 22; Male = 59%; Mean Age (SD) = 67 (10.3); Time Post Stroke (SD) = 1.8 (0.9) years).

Suggested MCID = 34.4 meters

Chronic Stroke:

(Perera et al, 2006, Geriatrics and Stroke)

MCID = 50 meters

Cut-Off Scores

Subacute Stroke:

(Fulk et al., 2017; n = 441 people 2-months post-stroke (secondary analysis of datasets from 2 stroke trials (Locomotor Experience Applied Post-Stroke (LEAPS) and Functional Ambulation: Standard Treatment vs. Electrical Stimulation (FASTEST) trials); Mean age = 61.4 (12.4) years)

Household ambulator = 100 - 2,499 steps/day
Most limited community ambulator = 2,500 - 4,499 steps/day
Least limited community ambulator = 5,000 - 7,499 steps/day
Unlimited community ambulator ≥ 7,500 steps/day
Household ambulator 6MWT cut-off = 135.1 ± 84.4 meters (m)
Most limited community ambulator 6MWT cut-off = 225.2 ± 94.3 m
Least limited community ambulator 6MWT cut-off = 251.0 ± 79.6 m
Unlimited community ambulator 6MWT cut-off = 312.2 ± 70.9 m

(Kubo, et al., 2020; n = 110; stroke patients admitted to the rehabilitation unit ≤ 30 days post stroke)

Walking independence in stroke cut-off = 304 m (AUC = 0.905, sensitivity = 0.833, specificity = 0.900)
6MWT score of 141.8 m cut-off for Functional Ambulation Category (FAC) 2
6MWT score of 224.5 m cut-off for (FAC) 3
6MWT score of 352.6 m cut-off for (FAC) 4
6MWT score of 448.8 m cut-off for (FAC) 5

Chronic Stroke:

(Regan et al., 2020; n = 66; Mean age = 66 (12); secondary data analysis from 2 stroke studies)

6MWT increased fall risk cut-off of < 331.65 meters fall risk as defined as an Activity Specific Balance Confidence Scale (ABC) score of < 81.1

Normative Data

Stroke:

(Wevers et al, 2011, Chronic Stroke)

6MWT Outcome (n = 27)
Variable	Mean (SD)	Range
GPS 1st Measurement, m	408 (132)	133-700
GPS 2nd Measurement, m	417 (139)	127-695
MW 1st Measurement, m	413 (127)	129-664
MW 2nd Measurement, m	422 (132)	125-668
6MWT: six-minute walk test; GPS: global positioning system; MW: measuring wheel; SD: standard deviation

Test/Retest Reliability

Acute Stroke:

(Cheng et al., 2020; n = 17; Ambulatory adults with acute (< 1 month), subacute (1-6 months), and chronic (>6 months) stroke; mean age = 61; 88% ischemic stroke; 10 (59%) independent without use of assistive device)

Excellent test-retest reliability for measures of 6MWT using a 15-meter walkway and aphasia friendly pictorial instructions taken 3 days apart (ICC = 0.97, n = 16)
Excellent test-retest reliability for measures of 6MWT using a 30-meter walkway and aphasia friendly pictorial instructions taken 3 days apart (ICC = 0.94, n = 16)

(Fulk et al, 2008; n = 35 patients who are enrolled in inpatient rehabilitation after stroke; mean age = 67.4 (13.8) years; mean time since stroke onset = 34.5 (17.7) days, Acute Stroke)

Excellent test-retest reliability for all participants (ICC = 0.862)
Excellent test-retest reliability for those who require physical assistance to walk (ICC = 0.97)
Excellent test-retest reliability for those who can walk without assistance (ICC = 0.80)
Excellent test-retest reliability for those require an assistive device to walk (ICC = 0.914)

Chronic Stroke

(Eng et al, 2004; n = 12 community-dwelling individuals who had a stroke with moderate motor deficits; mean time since stroke onset = 3.5 (2.0) years; mean age = 62.5 (8.6) years, Chronic Stroke)

Excellent test-retest reliability (ICC = 0.99 distance in meters)
Excellent test-retest reliability for VO2 (ICC = 0.99)

(Flansbjer et al, 2005, Chronic Stroke)

Excellent Test-retest reliability (ICC = 0.99)

(Wevers et al, 2011, Chronic Stroke)

Excellent test-retest reliability between first and second 6MWTs outdoors (ICC = 0.96 for GPS and 0.98 for measuring wheel)

Interrater/Intrarater Reliability

Acute Stroke:

(Kosak & Smith, 2005; n = 18; female = 12; mean age = 77 (11) years; mean time since stroke onset = 28 (34) days; enrolled in inpatient rehabilitation; mean FIM score at time of admission to inpatient rehabilitation = 68 (17), Acute Stroke)

Adequate Intra-rater reliability (ICC = 0.74)
Excellent Inter-rater reliability (ICC = 0.78)

Criterion Validity (Predictive/Concurrent)

Acute Stroke

(Cheng, et al., 2020)

Excellent correlation of the 6MWT using aphasia friendly pictorial instructions and the 15- and 30-meter walkway lengths (Pearson correlation coefficients = 0.80 - 0.95, p < 0.001)
Excellent correlation of the 6MWT using aphasia friendly pictorial instructions and the 15- and 30-meter walkway lengths with the 10MWT using aphasia friendly pictorial instructions (Pearson correlation coefficients = 0.80 - 0.95, p < 0.001)
Poor to Adequate correlation of the 6MWT using aphasia friendly pictorial instructions and the 15- and 30-meter walkway lengths and the strength subscale scores on the Stroke Impact Scale (Pearson correlation coefficients = 0.27 - 0.48, p < 0.001)

(Harmsen, et al., 2017; n = 27, mean age = 43 (8.9), male = 8 (30%), mean Glasgow Coma Scale (GCS) score = 13.7 (2.3), 17 (63%) with anterior aneurysm location, acute stroke patients at time of move from ICU to medical floor with confirmed subarachnoid hemorrhage on CT scan)

Excellent concurrent validity of six minute walking distance with VO2 peak (r = 0.75, p < 0.001)

(Kosak & Smith, 2005, Acute Stroke)

Excellent correlation of the 6MWT with the:
- 2 min walk test (r = 0.997)
- 12 min walk test (r = 0.994)

Subacute Stroke:

(Clague-Baker et al., 2019; n = 40, mean age = 68.27 (13.38) years; , 6 months post-stroke; The Holland 6MWT protocol was used in this study)

Adequate positive correlation between the Incremental Cycle Test (ICT) and the 6MWT (r = 0.55, 95% CI = 0.35 to 0.71, p < 0.001)
Excellent correlation with ICT for the 17 patients with no residual (ISWT: r = 0.79, p < 0.001; 6MWT: r = 0.826, p < 0.001) compared to mild-to-moderate neurological impairment (ISWT: r = 0.45, p = 0.03; 6MWT: r = 0.38, p = 0.08)
Adequate predictive validity of 6MWT cut-off score of 288 m (AUC = 0.759, p = 0.09) to predict most/least limited and unlimited community ambulators (Sn = 60%, Sp = 77%)
Adequate predictive validity of combined 6MWT and Fugl Meyer score (AUC = 0.795) cut-off of 7.54 points to predict most/least limited and unlimited community ambulators (Sn = 70%, Sp = 75%)

Chronic Stroke:

(Laswati, et al., 2020; n = 38; age range = 32-65 years, 32 (84.21%) unilateral hemiparesis and 6 (15.79%) bilateral hemiparesis, subjects >2 weeks and up to 1 year post-ischemic stroke)

Excellent correlation in 6MWT results between mileage (meters) and VO2 max (r = 0.680, p = 0.000)
Excellent correlation in 6MWT results between VO2 max and 10MWT at both self-selected speed (r = 0.704, p = 0.000) and fast speed (r = 0.687, p = 0.000)

(Dunn, et al., 2019; n = 23; mean age = 61.5 (18.4) years; male = 11 (47.8%); ambulatory persons < 1 year after stroke; a 20 meter walkway length was used due to space limitations w/all other ATS guidelines followed)

No significant difference in VO2 peak (min-max: 17.08--18.09 mL kg-1 min-1) in 6MWT as compared with the shuttle walk test (SWT) and graded exercise test (GXT)
Significantly lower HR (p = 0.005) in the 6MWT compared with the SWT and GXT
Excellent correlation between 6MWT VO2 peak and distance (r = 0.78)

(Kwan, et al., 2019; n = 30 (plus n = 30 healthy controls); mean age = 65 (15) years; chronicity = 25 (30) months; good lower limb strength (i.e., ≥ grade 4, walking speed > 0.6 m/s without aids in bare feet)

Adequate correlation between Lower Extremity Motor Coordination Test (LEMCOT) scores and walking performance in the 6MWT (r = 0.50, p = 0.01) and the 10MWT (r = 0.42, p = 0.02)

(Awad, et al., 2019; n = 40; mean age = 58.4 (1.6) years; mean years post-stroke = 2.9 (0.7))

Change in 6MWT minute 1 steps vs. 6MWT minute 6 steps that declined by 0.10 m/second or more presented with significantly less steps/day in community walking, accounting for 71% of the variance in community walking as compared to the 6MWT overall score, which accounted for 41% of the variance in community walking.

(Ribeiro, et al., 2019; n = 23, mean age = 60 (9), age range = 40 - 80 years, 96% ischemic stroke; 65% left side, 75% inactive (0 steps/minute) with low steps/day (3,878) and almost no time in medium or high cadence (6%); subjects divided into short distance walkers (< 288 m) and long distance walkers (≥ 288 m) based on 6MWT results using a 30 m corridor)

Short distance walkers had a significantly higher energy cost of walking (calculated as mean O2 steady state uptake divided by walking speed) (mean = 0.39 (0.21)) than long distance walkers (mean = 0.18 (0.05), t = -4.331, p < 0.001)

(Woodward, et al., 2019; n = 53; mean age = 59 (8.8); right hemiparesis = 28)

Excellent concurrent validity between 6MWT-SSV (Self-Selected Velocity) and 6MWT-FV (Fastest Velocity) (r = 0.95, p < 0.01)
Adequate concurrent validity between 6MWT-SSV and VO2 peak on the Graded Exercise Test (GXT) (r = 0.41, p < 0.01)
Excellent concurrent validity between 6MWT-SSV and speed on the GXT (r = 0.84, p < 0.01)
Adequate concurrent validity between 6MWT-FV and VO2 peak on the Graded Exercise Test (GXT) (r = 0.53, p < 0.01)
Excellent concurrent validity between 6MWT-FV and speed on the GXT (r = 0.88, p < 0.01)

(Wevers, et al, 2011, Chronic Stroke)

Excellent concurrent validity between the first outdoor 6MWT using GPS and the first outdoor 6MWT using the measuring wheel (r = 0.98, p < 0.00)
Excellent and between the second outdoor 6MWT using GPS and the second outdoor 6MWT using the measuring wheel (r = 0.99, p < 0.00)

(Patterson, et al, 2007, n = 74, mean age = 64 (10) years; time since stroke onset 48 (59) months; dichotomized based on median speed, Chronic Stroke)

Results indicate that faster walkers had significantly higher (p < 0.02) values on:
- Berg Balance Scale
- VO2peak measurements
- Covered more distance during the 6-minute walk
- Paretic leg strength
- Nonparetic leg strength

(Flansbjer, et al., 2005, chronic stroke)

Excellent concurrent validity of 6MWT with:
- TUG (r = -0.89)
- 10 meter comfortable gait speed (r = 0.84)
- 10 meter fast gait speed (r = 0.94)
- Stair Climbing Ascend (r = -0.82)
- Stair Climbing Descend (r = -0.80)

Responsiveness

Stroke:

(Kosak & Smith, 2005, Stroke)

Responsiveness to change over a 3.9 (2) week inpatient rehabilitation stay for the 2-, 6-, and 12-minute walking tests as measured by standardized response mean (SRM) scores was 1.34, 1.52, and 1.90 (F = 24.24, p < 0.01), respectively.

Minimal Detectable Change (MDC)

COPD:

(Redelmeier et al, 1997; n = 112 patients with COPD; mean age = 67 years; mean FEV1 = 975 ml, COPD)

MDC = 54 meters (177 feet)

Minimally Clinically Important Difference (MCID)

COPD:

(Rasekaba et al, 2009; review article, COPD)

MCID = 54 meters

Normative Data

COPD:

(Casanova et al, 2007; Szekely et al, 1997, COPD)

Average distance walked: 380 m (range 160-600 m)
Distance < 200 m is predictive of hospitalization or mortality
Significant decline in 6MWD demonstrated in healthy adults as age increases
Geographic variations also noted in 6MWD

(Szekely et al, 1997, COPD)

Inability to walk > 200m before the operation and resting PzCO₂ > 45 were the best predictors of unacceptable postoperative outcome
Distance < 200m is predictive of hospitalization or mortality

Criterion Validity (Predictive/Concurrent)

COPD:

(Szekely et al, 1997; n = 47, average age 60.5 (7.5) years, individuals undergoing volume reduction surgery, COPD)

Inability to walk > 200m before the operation and resting PzCO₂ > 45 were the best predictors of unacceptable postoperative outcome and mortality (specificity = 84%, sensitivity = 82%)
Adequate correlation with length of hospital stay:
- Pre-surgical 6MWT (R = 0.32)
- Post-surgical 6MWT (R = 0.40)

Responsiveness

COPD:

(Casanova et al, 2007, COPD)

Demonstrates significant decline in those individuals with severe airflow limitation (FEV1 < 50%)
Decline worsened with disease severity

Test/Retest Reliability

TBI:

(Mossberg, 2003, n = 23; mean age 35.5 (12.5) years male, 30.5 (12.8) years female; approximately 12 months since injury, TBI)

Excellent test re-test reliability (ICC = 0.94)

(VanLoo et al, 2004, n = 13; mean age = 32.5 (11.3) years; average time post injury 11.9 (15.7) months; mean initial GCS 5.8 (2.9); mean PTA 43.8 (39.1) days, TBI)

Excellent test re-test reliability (ICC = 0.96)

Face Validity

TBI:

(Moseley et al, 2004, n = 10, mean age 31.9 (14.2) years, mean days post injury = 56.4 (25.5); mean duration of PTA = 26.6 (8.7) days, TBI)

Poor to adequate correlation with 10 meter walk test in various environments:
- Poor correlation when tested in car park of a metropolitan shopping center and inside shopping center: ICC = 0.06, 0.18 respectively
- Adequate correlation tested in clinical environment: ICC = 0.37

Normative Data

Chronic Heart Failure:

(Rasekaba et al, 2009, Chronic Heart Failure)

Average distance walked: 310-427 meters depending on the severity of heart disease
Distance has in inverse correlation with the New York Heart Association (NYHA) functional class
Ranging from 502-743 meters depending on age, sex, height, weight, predicted heart rate max

Average distance of 238-388 meters for subjects with COPD

Healthy Adults:

(Enright el al, 1998, Healthy Adults)

Gender specific regression equations can be used to explain 40% of the variance in distance walked
6MWD significantly less for men and women who are heavier, older and for shorter men

Healthy Adults:

(Enright el al, 1998, Healthy Adults)

Gender specific regression equations can be used to explain 40% of the variance in distance walked
6MWD significantly less for men and women who are heavier, older and for shorter men

Modified 6MWT:

(Geiger et al, 2007; n = 528 children between 3 and 18 years old, Modified 6MWT)

Modified 6MWT Distance in Children
Age	Male	Female
3-5 yrs	536.5 (95.6)	501.9 (90.2)
6-8 yrs	577.8 (56.1)	573.2 (69.2)
9-11 yrs	672.8 (61.6)	661.9 (56.7)
12-15 yrs	697.8 (74.7)	663.0 (50.8)
16-18 yrs	725.8 (61.2)	664.3 (49.5)

Mixed Populations: (McKay et al., 2017; n = 1,000; mean (SD) = 647 (127.0))

Reference values for the 6-Minute Walk Test by age group and sex (meters)

Age Group (years)	Male (mean (SD), n)	Female (mean (SD), n)
3-9	550 (117.6), 70	556 (119.4), 70
10-19	748 (103.9), 80	693 (83.6), 80
20-59	736 (88.3)^a, 200	674 (76.8), 200
60+	599 (125.4)^a, 150	550 (115.0), 150

^aSignificant sex differences, p < 0.01

Minimally Clinically Important Difference (MCID)

Multiple Sclerosis: (Oosterveer et al., 2022; n = 118, mean age = 48.2 (10.5), male = 28 (23.7%), mean years since diagnosis = 12.3 (8.9), relapse-remitting MS = 96 (81.4%), hospital patients tested at routine annual check-up, minimal important change determined by anchor-based predictive modelling method)

Minimal Important Change (adjusted) for improvement = 19.7 meters (95% CI: 9.8-30.9 m)
Minimal Important Change (adjusted) for deterioration = 7.2 meters (95% CI: -3.3-18.2 m)

Normative Data

Multiple Sclerosis: (Skjerbaek et al., 2023; n = 228, mean age = 53.7 (11.6), age range = 26-81, female = 156 (68%), time since diagnosis = 12.6 (9.9) years (range = 0-49), inclusion criteria: written consent to participate, diagnosis of MS according to the McDonald criteria, and patient-determined disease step (PDDS) score ≤ 7; Danish population)

Walking capacity and ability in Danish MS patients and healthy controls

Test	Multiple Sclerosis	Healthy Controls
Walking Capacity
T25FWT, (m/s)	1.37±0.55 (0.07-2.78)	1.91±0.28^a
6MWT, (m)	416±163 (8-755)	638±83^b
SSST, (rounds/s)	0.108±0.054 (0.007-0.272)	0.184±0.037^c
Walking ability
MSWS	35.6±13.7 (12-60)	not applicable

T25FWT (n = 227): timed 25-foot walk test; 6MWT (n = 219): six-minute walk test; SSST (n = 223): six-spot-step-test; MSWS: multiple sclerosis walking scale (12-item). Data are mean ± SD (range)

^aDerived from Bohannon (1997) and Bohannon & Wang (2018) (n = 1197)

^bDerived from Tveter et al. (2014) and McKay et al. (2017) (n = 1070)

^cDerived from Brincks & Callesen (2022), Sieljacks et al. (2020), Riemenschneider et al. (2021), and three ongoing studies (n = 253)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Multiple Sclerosis: (Chen et al., 2021; n = 60 (40 MS patients and 20 healthy controls), age range = 18-64, Expanded Disability Status Scale (EDSS) score ≤ 6.5, subjects completed three repeated 6MWT’s in a single day)

Excellent predictive ability of model including 6MWT gait speed trajectory, 6MWT total distance, age, and sex (AUROC = 0.93, 95% CI: 0.86-0.99)
Adequate predictive ability of model including change in 6MWT gait speed, 6MWT total distance, age, and sex (AUROC = 0.85, 95% CI: 0.76-0.94)
Adequate predictive ability of model including 6MWT total distance, age, and sex (AUROC = 0.83, 95% CI: 0.73-0.93)

Construct Validity

Convergent validity:

Multiple Sclerosis: (Wetzel et al., 2010; n = 64, male = 23, mean age = 49.3 (9.8), mean EDSS score = 3.8 (1.6), exclusions: < 18 years of age; EDSS score > 6.5; current smokers; or diagnosed acute respiratory infection, oral temperature > 100 degrees F, or unstable cardiopulmonary or musculoskeletal condition unrelated to MS that could affect performance or safety)

Excellent convergent validity between Activities-specific Balance Scale and 6MWT (r = 0.771, p < 0.01)
Excellent convergent validity between Functional Stair Test and 6MWT (r = 0.756, p < 0.01)
Adequate convergent validity between EDSS score and 6MWT (r = -0.588, p < 0.01)
Adequate convergent validity between Sit to Stand Test and 6MWT (r = -0.571, p < 0.01)
Adequate convergent validity between single limb or tandem balance test and 6MWT (r = 0.395, p < 0.01)
Adequate convergent validity between predicted maximal inspiratory pressure and 6MWT (r = 0.314, p < 0.05)
Adequate convergent validity between maximal expiratory pressure observed (r = 0.404, p < 0.01) and predicted (r = 0.302, p < 0.05) and 6MWT
Adequate convergent validity between maximal voluntary ventilation observed (r = 0.304, p < 0.05) and predicted (r = 0.321, p < 0.01) and 6MWT
Poor convergent validity between observed maximal inspiratory pressure (r = 0.281, p < 0.05) and 6MWT

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Atomized Content

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Required Training Description

Instrument Reviewers

Body Part

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Normative Data

Test/Retest Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Responsiveness

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Test/Retest Reliability

Minimal Detectable Change (MDC)

Test/Retest Reliability

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Normative Data

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Content Validity

Responsiveness

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Responsiveness

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Normative Data

Criterion Validity (Predictive/Concurrent)

Responsiveness

Test/Retest Reliability

Face Validity

Normative Data

Minimally Clinically Important Difference (MCID)

Normative Data

Criterion Validity (Predictive/Concurrent)

Construct Validity

Bibliography

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