Reliability and learning effect for ISWT
Only a handful of studies have reported the reliability of the ISWT, with most data in COPD. One study
documented an ICC of 0.88 (95% CI 0.83–0.92) [78]. Another study reported an ICC of 0.89 [79]. These
two studies suggest that the association between test–retest walk distances is strong, with the majority
of variability being attributable to between-subject differences. More studies are needed to confirm
these findings.
There is a small but statistically significant difference between the first two ISWTs performed (mean
differences of 20 and 25 m for tests performed on the same day, and 23.5 m for tests performed on different
days) [6, 80, 81]. The effect of learning on the ISWT is large enough to be clinically important when
evaluating change over time. It is recommended that two ISWTs be performed and the best distance
recorded. It remains to be established whether one test would be sufficient where the ISWT is used as a oneoff
measure to stage disease or assess risk (e.g. likelihood of hospitalisation or mortality). Whether one test
is sufficient if the test has previously been conducted, similar to the 6MWT, is still unclear. It is common to
repeat the test once after an intervention, but whether this underestimates the impact of the intervention
remains to be established. The reliability of the test in chronic respiratory diseases other than COPD has not
been explored.
Reliability and learning effect for ISWTOnly a handful of studies have reported the reliability of the ISWT, with most data in COPD. One studydocumented an ICC of 0.88 (95% CI 0.83–0.92) [78]. Another study reported an ICC of 0.89 [79]. Thesetwo studies suggest that the association between test–retest walk distances is strong, with the majorityof variability being attributable to between-subject differences. More studies are needed to confirmthese findings.There is a small but statistically significant difference between the first two ISWTs performed (meandifferences of 20 and 25 m for tests performed on the same day, and 23.5 m for tests performed on differentdays) [6, 80, 81]. The effect of learning on the ISWT is large enough to be clinically important whenevaluating change over time. It is recommended that two ISWTs be performed and the best distancerecorded. It remains to be established whether one test would be sufficient where the ISWT is used as a oneoffmeasure to stage disease or assess risk (e.g. likelihood of hospitalisation or mortality). Whether one testis sufficient if the test has previously been conducted, similar to the 6MWT, is still unclear. It is common torepeat the test once after an intervention, but whether this underestimates the impact of the interventionremains to be established. The reliability of the test in chronic respiratory diseases other than COPD has notbeen explored.
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