6 minute walk test Flashcards
Widely used as an indicator of functional capacity
Why 6 minutes?
- Two-minute walk test is less discriminatory
- Twelve-minute walk test is too long for most pulmonary patients
- 6 minute has been shown most effective-requires little equipment if any and is low cost
• Uses
- Before rehab program to:
• Assess pt. exercise capacity and disease severity • Set exercise prescription-where to start/what to accomplish
-After rehab program - as evaluation tool for physical reconditioning component
- Part of selection criteria of when to place patients on the lung transplant list -said to be useful predictor of survival/success in lung transplant patients
- Assessment tool for pre-surgical assessment and post-surgical rehab progress
• Testing Environment
- Safe area that is easily accessible
- Indoors, along a flat, straight, enclosed corridor with a hard surface
- At least 100 feet of measured walking distance
- Unobstructed
- Rest area interspersed along route for sitting/standing
- Room temperature and humidity comfortable
• Prior to Testing
- Measure
• Blood pressure
• Heart rate
• Respiratory rate
• Resting blood saturation
• At home oxygen at correct prescription (if any)
- Familiarize the patient with the Modified Borg Dyspnea
Scale
- Have patient rate their perception of dyspnea at rest before the walk
• Clinician’s role:
- walk slightly behind patient to not “pace” patient
- Encourage and instruct patient during test
• Patient should have taken any regularly scheduled meds and eaten at least 1 hour before test
• Instructions the patient to
wear comfortable shoes, bring cane or any assistive devices including oxygen if prescribed
- cover as much distance as possible during time allowed
- no talking during the walk
- may stop and rest at any time
- During and at conclusion, rate dyspnea again
• Test may be repeated a second time after an adequate rest period-at least 30 minutes apart
• Reasons to immediately stop the test!
- chest pain
- intolerable dyspnea
- leg cramps
- staggering gait
- diaphoresis
- pale or ashen/gray appearance
• Supplies to have on hand
- Pulse oximeter
- Oxygen (portable)
- sublingual nitroglycerin
- aspirin
- Albuterol
- stopwatch
- access to phone for paging rapid response team or emergency plan in place (prefer MD in building or close by)
Desalination Guidelines • Patients who desaturate to <88% on room air during test
• Patients who desaturate to <88% on room air during test
- place on oxygen at 2 L/minute until the desired SpO2
reached (usually 93%)
- after 20 minutes on oxygen, MD usually wants to get ABG
- if ABG is adequate(not critical), repeat six-minute walk test on 2 L/min oxygen
- if patient does not desaturate during the repeat test on 2
L/min, obtain and order for patient to use oxygen at 2
L/min with activity
Desalination Guidelines • Patients who desaturate to <88% on their current prescribed oxygen
• Patients who desaturate to <88% on their current prescribed oxygen
- increase liter flow by 1 L/min for 20 minutes
- repeat six-minute walk test on increased liter flow
- if patient does not desaturate during repeat test on increased liter flow, obtain order for oxygen use with the new liter flow during activity
- MD may want an ABG on new oxygen prescription
• Patients who measure an SpO2 <88% on arrival are NOT tested
Pulse oximery devices
• Pt. assessed for low perfusion/abnormal Hgb
• No nail polish
• Motion artifact taken into consideration (remember: look at pleth reading on pulse oximeter)
• Accuracy of results
- Ensure batteries in device are adequate
- Is their correlation between palpated pulse and pulse shown on oximeter device
- clinical appearance of patient vs. reading given
- condition and placement of probe
Oxygen delivery devices
• If patient does not currently have oxygen prescribed, walk should be performed on room air
• If patient has oxygen currently prescribed, recommended to use their own personal system (continuous flow or pulse delivery) via tank or portable concentrator
Included in test results
• for each minute during walk and after recovery phase
- distance
- heart rate
- saturation
Included in test results
• In comment section:
- dyspnea assessment at conclusion of walk
- medications taken before or during testing
- oxygen use (and if carried/pushed by patient or therapist) - both liter flow and type of delivery device used
- patient symptoms/limitations during walk
- use of any supportive devices, i.e. cane, walker, pushing wheelchair
