Brief report
The Shuttle Walk Test: A New Approach to Functional Walking Capacity Measurements for Patients After Stroke?

Presented in part to the Congress of the Royal Dutch Society for Physical Therapy (KNGF), December 2, 2010, Amsterdam, The Netherlands.
https://doi.org/10.1016/j.apmr.2011.08.012Get rights and content

Abstract

van Bloemendaal M, Kokkeler AM, van de Port IG. The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke?

Objective

To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke.

Design

Clinimetric study.

Setting

Three rehabilitation centers in the Netherlands.

Participants

A sample of patients after stroke (N=75; mean age ± SD, 58.8±9.8y) who are capable of walking without physical assistance. Patients were excluded if they had sustained a subarachnoid hemorrhage or a stroke in the cerebellum or brainstem, or had any other conditions that limited their walking capacity more than the current stroke, or had sensory aphasia.

Interventions

Not applicable.

Main Outcome Measures

Construct validity (6-minute walk test [6MWT]) and test-retest reliability of the SWT were assessed. Measurement error was determined with the standard error of measurement (SEM), limits of agreement, and smallest detectable differences (SDDs).

Results

Construct validity was confirmed by high significant correlations (rp≥.65, P<.01) between the SWT and 6MWT. Difference scores were significantly higher in favor of the SWT for high-speed walkers (≥0.8m/s). In the small group (n=12) of low-speed walkers (<0.8m/s), no significant correlations and differences between both tests were found except for walking distance in favor of the 6MWT. Test-retest reliability was good (intraclass correlation coefficient model 2,1 [ICC2,1]=.961 [.936–.977]). SEM was 6.0%, and the SDDs for individual and group were 302.0m (37%) and 38.7m (5%), respectively.

Conclusions

The SWT is a valid and reliable measure and therefore a feasible instrument to determine functional walking capacity of patients after stroke, especially in high-speed walkers.

Section snippets

Methods

Patients after stroke who received rehabilitation between January and April 2010 in 1 of 3 rehabilitation centers in the Netherlands were asked to participate. In addition, a convenience sample of discharged patients was recruited from the 2006 through 2009 database of 1 rehabilitation center. Inclusion criteria were (1) stroke verified by a physician; (2) age between 18 and 80 years; (3) walking without physical assistance; and (4) understanding simple instructions. Exclusion criteria were (1)

Results

Not all 75 participants (table 1) were able to participate in both examinations (validity and reliability), because of the time poststroke (n=7), planning problems (n=14), or physical problems on the second measurement day (n=1).

Discussion

The SWT is a reliable test to measure functional walking capacity of patients after stroke. Both hypotheses on construct validity were confirmed, and the measurement error and SDD/SD ratio were within the boundaries described in literature. Even though the 6MWT has some disadvantages, the 6MWT was used to determine construct validity because it is the most frequently used instrument in research and clinical practice. No systematic differences were found between the repeated tests, indicating

Conclusions

The SWT can be performed in groups and requires less space to conduct than the 6MWT. This, together with its sound measurement properties, favors the use of the SWT to determine functional walking capacity, especially for patients after stroke who have a relatively high walking speed.

Suppliers

  • a

    Polar Electro Inc. 1111 Marcus Ave, Ste M15 Lake Success, NY 11042-1034.

  • b

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

Acknowledgments

We thank the rehabilitation centers that participated in this study: Merem De Trappenberg, Huizen; De Hoogstraat, Utrecht; and Aardenburg Military Rehabilitation Center, Doorn. We also thank the assistants who helped carry out the SWTs, and A. Beelen, PhD, for critically reviewing the manuscript.

References (12)

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