The six-minute walk test as a fall risk screening tool in community programs for persons with stroke: a cross-sectional analysis.
Elizabeth Regan, Addie Middleton, Jill C Stewart and 3 others
PMID 31622172WHAT IT FOUND
In 66 adults with chronic stroke, walking under 331.65 m on the six-minute walk test was associated with being in an increased fall risk group.
It is a screening association, not proof it predicts actual falls.
Key findings
01Six-minute walk test distance was significantly associated with fall risk group (chi-square = 8.54, p = 0.003; odds ratio 0.995).
02A 331.65 m cutoff had sensitivity 0.744 and specificity 0.630; using the sample's 59.1% pre-test probability, a distance below it gave a 74.3% probability of increased fall risk, and a distance at or above it gave a 36.9% probability.
03Fall risk was defined by an Activities-Specific Balance Confidence score below 81.1, and the study did not collect actual fall counts.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was cross-sectional and did not record actual falls, so it tested association with a balance-confidence cutoff, not fall prediction. Fall risk was defined by an Activities-Specific Balance Confidence score below 81.1, based on an earlier study, not by prospective fall counts. The sample was 66 adults with chronic stroke who were ambulatory and community-dwelling, so the results apply only to people matching those characteristics. The diagnostic accuracy numbers were: area under the curve 0.701, sensitivity 0.744, specificity 0.630, positive likelihood ratio 2.01, negative likelihood ratio 0.406, and the paper notes the likelihood ratios fell in the weak diagnostic category. The model classified 66.7% correctly, and the odds ratio was 0.995, with the paper stating a 0.5% lower likelihood of increased fall risk for each additional meter walked. Data came from two studies with different raters, although standard procedures were used. Stroke chronicity was not a significant predictor in the model (p = 0.055).
Declared interests
The supplied publication types list NIH extramural and non-U.S. government research support. The provided article text does not state author conflicts of interest.
The easy way to misread this
Do not use the 331.65 m cutoff to say a patient with stroke will fall. The study did not record actual falls; it only revised the probability of increased fall risk from 59.1% to 74.3% for distances below the cutoff.