편마비 환자의 보행치료로서 6분걷기검사의 사용: 결과지식 제공을 통한 연습효과의 가능성
Use of the 6-Minute Walk Test as Gait Therapy for Hemiplegic Patients: Possibility of Practice Effect by Providing Knowledge of Result
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연구배경: 편마비 환자를 대상으로 보행치료로서 6분걷기검사의 사용과 결과지식을 제공한 연습효과의 가능성을 알아보고자 시행되었다. 방법: 본 연구는 편마비 환자 16명을 대상으로 하여 세 조건(KR-없음, 즉시-KR, 통합-KR)에서 6분걷기검사를 시행하였다. 즉시-KR은 6분걷기검사 동안 20 m 마다 즉시 보행시간을 알려주었고, 통합-KR은 6분걷기검사를 종료한 후 각 60 m 마다 측정한 보행시간을 알려주었다. 6분걷기검사를 종료한 후에는 각 조건에서 6분 동안의 전체 보행 거리에 대한 되먹임을 제공하였다. 결과: 각 조건의 일치도 분석에서 세 조건 모두 연습 효과를 인정할 만한 범위에 포함되지 않았지만, 6분걷기검사의 전후 비교는 즉시-KR 조건에서만 유의한 차이를 보였으며(p<.05), Bland-Altman plot에서의 2회 측정에 대한 차이값과 평균값의 분포 범위는 즉시-KR에서 가장 넓은 것으로 나타났다. 각 조건 간 전후 차이값의 비교에서는 KR-없음과 즉시-KR 조건에서는 유의한 차이가 있는 것으로 나타났다. 결론: 본 연구는 6분걷기검사의 세 조건들에 대한 연습 효과를 충분히 설명하지 못하였지만, 즉시-KR 조건에서 6분걷기검사가 수행될 경우 연습 효과의 가능성이 가장 높아지는 것으로 나타났다
Abstract
Background: This study aimed to investigate the practice effect of the 6-minute walk test (6MWT) after providing the subjects with knowledge of the results (KR). Methods: Sixteen subjects with post-stroke hemiparesis volunteered to participate in this study. The 6MWT was performed by having the subjects take repeated walks along a 20-m walkway for 6 minutes; and the maximum distance walked was recorded. Two trials of the 6MWT were conducted under three conditions: no-KR, immediate-KR (providing knowledge of the time taken to complete each 20-m distance), and summary-KR (providing knowledge of the time taken to complete 60 m). Results: The practice effects of all 3 conditions were determined by using the paired t-test, intraclass correlation coefficient (ICC) with <0.75, and the Bland-Altman plot. The findings of the paired t-test showed a significant difference under the immediate-KR condition only; however, no significant differences were noted under the no-KR and summary-KR conditions. In a data agreement analysis across the two trials using the ICC, none of the obtained values under the three conditions were in an acceptable range indicative of a practice effect. In the Bland-Altman plot, a greater data variation was observed under the immediate-KR condition than under the other two conditions. When comparing the conditions, the immediate-KR condition differed significantly from the no-KR condition. Conclusions: Our findings do not support the presence of a practice effect across the 6MWT. However, a practice effect seems to be clinically possible when the immediate-KR condition is incorporated into this test.
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