The use of the practice walk test in pulmonary rehabilitation program: National COPD Audit Pulmonary Rehabilitation Workstream

Abstract

Our aim was to evaluate the use and impact of the practice walk test on enrolment, completion, and clinical functional response to pulmonary rehabilitation (PR) using the 2015 UK National Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Rehabilitation audit data. Patients were assessed according to whether a baseline practice walk test was performed or not. Study outcomes included use of the practice walk test, baseline and change in incremental shuttle walk test distance (ISWD) or 6-minute walk test distance (6MWD), and enrolment to and completion of PR program. Of 7,355 patients, only 1,666 (22.6%) had a baseline practice test. At baseline, the practice walk test group walked further as compared to the no practice walk test group: ISWD, 17.9 m [95% confidence interval (CI) 8.2–27.5 m] and 6MWD, 34.8 m (95% CI 24.7–44.9 m). The practice walk test group were 2.2 times (95% CI 1.8–2.6) more likely to enroll and 17% (95% CI 1.03–1.34) more likely to complete PR. Although the change in ISWD and 6MWD with PR was lower in the practice walk test group, they walked further at discharge assessment. Only 22.6% of the patients in the 2015 National PR audit had a practice walk test at assessment. Those who did had better enrolment, completion, and better baseline walking distance, from which the prescription is set.

Keywords:

• pulmonary rehabilitation
• COPD
• functional performance test
• functional exercise test

Acknowledgments

The National COPD Audit Program is commissioned by the Healthcare Quality Improvement Partnership (http://www.HQIP.org.uk) as part of the National Clinical Audit Program. The authors gratefully acknowledge the Royal College of Physicians COPD team who managed the audit collection and database. In particular, the authors would like to thank Juliana Holzhauer-Barrie, Viktoria McMillan, Muhammad Saleem Khan, and Emma Skipper. The authors would also like to acknowledge the pulmonary rehabilitation work-stream group. This study is based on data collected by or on behalf of the Healthcare Quality Improvement Partnership, who have no responsibility or liability for the accuracy, currency, reliability, and/or correctness of this study. This study is supported by both the National Institute for Health Research (NIHR) Nottingham and Leicester Biomedical Research Centers. The views expressed are those of the authors and not necessarily of the National Health Service, the NIHR, or the Department of Health. No other support was received from any other organization for the submitted work.

Author contributions

CEB and TMM devised the original idea and contributed to the design of the study and analysis of the data. AH, CEB, and TMM developed the analysis plan. AH did the data processing. CMR is the lead for the National COPD audit and assisted with the submission to HQIP for data. MCS is the lead for the pulmonary rehabilitation workstream of the National COPD audit, and SJS and CEB are members of the pulmonary rehabilitation audit workstream. AH, CEB, and TMM drafted the first draft. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

AH has carried out this study as part of his PhD program at University of Nottingham. He has received a scholarship award from Ministry of Education (Saudi Arabia). The authors report no other conflicts of interest in this work.