The six-minute walk test as a fall risk screening tool in community programs for persons with stroke: a cross-sectional analysis

ABSTRACT

Background and Purpose: Persons with stroke have increased risk for recurrent stroke. Group exercise programs like cardiac rehabilitation might reduce this risk. These programs commonly use the six-minute walk test to measure aerobic capacity. However, failure to assess fall risk may compromise safety for persons with stroke. The study aim was to determine the association between the six-minute walk test and fall risk in persons with stroke.

Methods: Cross-sectional analysis measured the association between the six-minute walk test and fall risk in 66 persons with stroke with a mean age of 66 years (SD 12) and median stroke chronicity of 60.9 months (range 6.0–272.1). The six-minute walk test was evaluated using logistic regression. The best fit model was used in Receiver Operating Characteristic analysis. Likelihood ratios and post-test probabilities were calculated.

Results: Lower six-minute walk test distance was associated with increased fall risk in logistic regression (p = .002). The area under the curve for the univariate six-minute walk test model (best fit) was 0.701 (p = .006). The cutoff for increased fall risk was six-minute walk test <331.65 m. The post-test probability of fall risk increased to 74.3% from a pre-test probability of 59.1%.

Discussion: The moderate association between fall risk and six-minute walk test suggests that in addition to assessing capacity, the six-minute walk test provides insight into fall risk/balance confidence.

Conclusion: Using the six-minute walk test cutoff to screen fall risk in community exercise programs may enhance safety for persons with stroke without additional testing required.

Keywords:

• Stroke
• fall risk
• community programs

Additional information

Funding

(1) 2019 American Heart Association Pre-Doctoral Fellowship(2) Foundation for Physical Therapy’s Center of Excellence in Physical Therapy: Health Services and Health Policy Research and Training Grant(3) University of South Carolina (USC) Behavioral-Biomedical Interface Program (NIGMS/NIH-T32 2T326M081740-11A1)(4) American Heart Association (Scientist Development Grant, 0835160N)(5) National Institutes of Health (U54GM104941)(6) Robert Wood Johnson Foundation (Health Games Research, grant 64450)