THE CHINESE (MANDARIN) VERSION OF THE SIX-MINUTE WALK TEST: A VALIDATION STUDY

M. Yeung¹, M. Lee^1,2, V. Tan^1,3, D. Wong^1,4, C. Yan^1,4

Background: The six-minute walk test (6MWT) is a submaximal field test which measures the distance an individual can walk in six minutes, also referred to as the six-minute walk distance (6MWD). The 6MWT is commonly used in clinical settings to assess an individual’s functional exercise capacity, treatment outcome or as an indicator of morbidity and mortality. The 6MWT has demonstrated to be a reliable and valid measure in various diseased population and healthy individuals. To date, a validated Chinese (Mandarin) 6MWT translated instructions is not available. Translation of the Chinese 6MWT is done in an ad hoc manner for the Chinese-speaking population, affecting the reliability of the test.

Purpose: To develop a valid and reliable Chinese (Mandarin) instructions of the 6MWT.

Methods: A set of Chinese (Mandarin) instructions of the 6MWT was translated from the original English instructions via the recommended “Process of translation and adaption of instruments” by the World Health Organisation. Content and face validity, inter-rater and intra-rater reliability of the Chinese (Mandarin) 6MWT instructions were established through the vigorous translation process which involved forward-backwards translation, an expert panel review and a pilot test. The Chinese (Mandarin) instructions were tested with 52 healthy adult participants for its validity. Each subject performed three trials of 6MWT and a cardiopulmonary exercise test over two consecutive days. The sequence of 6MWT was determined by randomization, such that each subject performed 6MWT in both English and Chinese (Mandarin) instructions while eliminating the learning effect. The 6MWD recorded from English and Chinese (Mandarin) 6MWT trials, and maximal oxygen consumption from the cardiopulmonary exercise test were analyzed.

Results: Intraclass correlation coefficient for inter-rater reliability was excellent (ICC=0.999, 95% confidence interval=0.996-1.000). Similarly, the intra-rater reliability across the three raters was high (R1: ICC=0.996, 95% CI=0.812-1.000; R2: ICC=1.000, 95% CI=0.994-1.000; R3: ICC=1.000, 95% CI=0.998-1.000). The 6MWD collected from the Chinese and English instructed 6MWT trials correlated positively with the maximal oxygen consumption respectively (r= 0.315, p= 0.023; r= 0.309, p= 0.026).

Conclusion(s): This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions. Future studies to investigate its reliability and validity in Chinese-speaking patients with various diseased conditions may be warranted.

Implications: The Chinese (Mandarin) instructions of the 6MWT can be used in clinical practice to ensure standardization of instructions.

Funding, acknowledgements: Singapore Institute of Technology, Health and Social Sciences Cluster.

Keywords: Six- minute walk test, Translation, Validation

Topic: Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Singapore Institute of Technology

Committee: Institutional Review Board

Ethics number: 2019089