Letter to the Editor
Six-minute walk tests and the secret races
Prueba de marcha de 6 minutos y las carreras secretas
Santiago C. Arce
Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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In case of unanimous (0–6 or 6–0) or draw (3–3) recommendations there is no statistical advantage when the decision is taken from 3 or 1 physicians. In the other cases, 3-physician decision is advantageous as compared with 1-physician decision. (B) Left: Distribution of 6-physician recommendations for the 40 patients with mild–moderate OSA (AHI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>events/h). Gray: recommendations resulting in no statistical advantage when the decision is made by 3 or 1 physicians; Black: recommendations for which decision-making by 3 instead of 1 physician increases correct decision probability. Right: Expected error in CPAP prescription when the decision is taken by 3 physicians (green column) instead 1 physician (brown column). (C) Same as in (B) but only for moderate OSA patients (15<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>AHI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40 events/h).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ramon Farré, Daniel Navajas, David Gozal, Josep M. Montserrat" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ramon" "apellidos" => "Farré" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Navajas" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Gozal" ] 3 => array:2 [ "nombre" => "Josep M." "apellidos" => "Montserrat" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289619302133" "doi" => "10.1016/j.arbres.2019.03.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302133?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919303027?idApp=UINPBA00003Z" "url" => "/15792129/0000005500000011/v1_201911020900/S1579212919303027/v1_201911020900/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Six-minute walk tests and the secret races" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "606" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Santiago C. Arce" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Santiago C." "apellidos" => "Arce" "email" => array:1 [ 0 => "arcesantiago@fibertel.com.ar" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prueba de marcha de 6 minutos y las carreras secretas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor:</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Humans are competitive by nature. They compete for food, for shelter, for well-being. Sometimes they even compete for abstract notions. Yet, are sports a staple of life?</p><p id="par0015" class="elsevierStylePara elsevierViewall">Many of us compete daily in what the Argentine writer Alejandro Dolina called “secret races”<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>: “What you do is, you choose someone in the street who is walking at a sprightly pace, and you try to catch up with them, before they reach a certain point. Running is strictly forbidden”, says Dolina in his rules. Who has never thought “I’m going to overtake the person with the red bag before they reach the corner”? The problems start when the tacit competitor realizes what is up and speeds up, a situation that can result in epic urban contests.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This behavior is inherent to human nature. Possibly with this in mind, the first consensus on the 6-minute walk test stated specifically that the patient should not be accompanied.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Surprisingly, the most recent ERS/ATS consensus specifies that the “assessor should not “pace” the patient during the test, but should walk behind such that measures (…) can be recorded without influencing the patient’s movement.”<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The standardization of tests should seek to eliminate all bias, and if it cannot be avoided, it should at least be mentioned in the final report. Should the physical characteristics of the assessor who conducted the test be included in the report? Will the distance and speed walked be the same if the patient is followed or not followed by a certain person? Will it be the same if the person doing the following is a burly nurse 2 meters tall and weighing 120<span class="elsevierStyleHsp" style=""></span>kg or a slender technician weighing 50<span class="elsevierStyleHsp" style=""></span>kg? And what will happen if the assessor has an unfriendly manner or if their voice does not command respect?</p><p id="par0030" class="elsevierStylePara elsevierViewall">All guidelines, even the most recent, emphasize that the 6-minute walk test should be performed at the patient’s own pace (self-paced), and that the main variable is the distance walked, measured in absolute values. A valid reason for accompanying the patient may be if the patient is thought to be in danger of falling, in which case the assessor should re-consider whether the patient should perform the test at all.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Another possible reason is the need to carry a bulky oximeter (weight<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>kg), but in this case, setting a secondary objective (minimum SpO<span class="elsevierStyleInf">2</span>) would skew the outcome of the primary objective (walking distance), a situation that is methodologically inappropriate.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, patients with permanent oxygen therapy might not be able to carry their own source of oxygen, and this should be transported by the assessor. In this case, it would be more reasonable for the oxygen supply to be carried by someone who habitually accompanies the patient on their outings (family, physical therapist, helper). The patient’s pace might not coincide with that of the assessor, and this would weaken the correlation of the test with their activities of daily living. In this case, the accompanying person must be identified, and attempts must be made to ensure that the same person participates in subsequent tests.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arce SC. Prueba de marcha de 6 minutos y las carreras secretas. Arch Bronconeumol. 2019;55:606.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El libro del fantasma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Dolina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1999" "editorial" => "Ed. Colihue" "editorialLocalizacion" => "Buenos Aires" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ATS statement: guidelines for the six-minute walk test" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.166.1.at1102" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2002" "volumen" => "166" "paginaInicial" => "111" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12091180" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S074937971730243X" "estado" => "S300" "issn" => "07493797" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:22 [ 0 => "A.E. Holland" 1 => "M.A. Spruit" 2 => "T. Troosters" 3 => "M.A. Puhan" 4 => "V. Pepin" 5 => "D. Saey" 6 => "M.C. McCormack" 7 => "B.W. Carlin" 8 => "F.C. Sciurba" 9 => "F. Pitta" 10 => "J. Wanger" 11 => "N. MacIntyre" 12 => "D.A. Kaminsky" 13 => "B.H. Culver" 14 => "S.M. Revill" 15 => "N.A. Hernandes" 16 => "V. Andrianopoulos" 17 => "C.A. Camillo" 18 => "K.E. Mitchell" 19 => "A.L. Lee" 20 => "C.J. Hill" 21 => "S.J. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00150314" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2014" "volumen" => "44" "paginaInicial" => "1428" "paginaFinal" => "1446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25359355" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005500000011/v1_201911020900/S1579212919302666/v1_201911020900/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005500000011/v1_201911020900/S1579212919302666/v1_201911020900/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919302666?idApp=UINPBA00003Z" ]
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