ESTABLISHING NORMATIVE VALUES FOR THE STAIR CLIMB TEST

Transcription

1 ESTABLISHING NORMATIVE VALUES FOR THE STAIR CLIMB TEST Introduction Gait speed is a useful tool in: Predicting morbidity and mortality Assessing fall risks and functional mobility Typically, gait speed is measured on level terrain over different distances or time intervals Makary, M. et al (2010); Afilalo J.et al ( 2010); Hardy S. et al (2007); Purser J. et al (2005) Cesari M. et al (2005) Studenski S. et al (2010) Wilken, et al (2012) 1

2 Introduction Many studies have been conducted on the use of stair climbing as an outcome measure, mainly because it is: Readily available Easily applicable and inexpensive May be more viable in some settings when compared with the Six- Minute Walk Test (6MWT) The Stair Climb Test (SCT), however, lacks standardization Wilken, et al (2012); Nightingale, et al (2014); Olsen, et al (1991); Van Nostrand, et al (1968); Bohdan, et al (2012); Ambrozin, et al (2013); Wyzer, et al (1999); Stephan, et al (2000); Girish, et al (2001); Cateneo, et al (2007); Cataneo, et al (2010); Paul, et al (2010); Brunelli, et al (2004); Brunelli, et al (2008); Koegelenberg, et al (2008); Bernasconi, et al (2012); Bean, et al (2007); Roig, et al (2010); Holden, et al (1992); Brunelli, et al (2008); Brunelli, et al (2012). Introduction Timed stair tests were introduced in the 1960s, primarily as a preoperative assessment tool for thoracic surgery patients Three main types of SCT used in literature: Symptom Limited Test Power Test Timed Stair Test Bohdan MP, et al. ( 2012); Olsen GN, et al (1991); Van Nostrand D et al (1968) 2

3 Existing Literature Nightingale et al. (2014): Systematic review of timed stair tests. Results (22 Studies - Ascent): ages 18-49:.48 (+/-.14) sec/step ages 50-65:.46 (+/-.17) sec/step ages 65+:.65 (+/-.41) sec/step Conclusions: Timed stair climb tests are: Quick, simple ways to assess function and fitness Responsive to age and functional level Great alternative for the 6MWT Significance of Present Research Quick, valid, and reliable measures are necessary to assess cardiovascular capacity Need a challenging test for higher functioning patients The SCT lacks normative values for the adult population The SCT has not been standardized or validated against the 6MWT The SCT may be more useful in space-limited inpatient, outpatient, and home care settings 3

4 Introduction Methodology adapted from Nightingale et al. (2014): Create consistent, reproducible testing method Instruct subjects to perform the SCT as quickly and as safely as possible Handrail should be used only for balance Flights tested should involve at least 10 steps per flight Research Questions What is the correlation, if any, between the SCT and 6MWT? Is the SCT a more challenging and viable alternative to the 6MWT in higher functioning individuals? What are the normative speed values on the SCT for the normal population? 4

5 Purpose To establish normative speed values in the adult population for height ascended during a SCT and to compare the SCT with the 6MWT Hypothesis A non-directional two-tailed hypothesis was used The hypothesis was two-fold: 1. Vitals taken after the SCT would show a significant correlation with vitals after the 6MWT and, 2. Speed of ascent on the SCT would show a significant correlation with distance walked on the 6MWT 5

6 Methodology Research Design Inclusion Criteria: Males and females between the ages of 20 and 60 Exclusion Criteria: Current injury Pregnancy Inability to climb a flight of stairs Use of an assistive device Existing medical condition that required examination by a physician prior to exercise as determined by the 2014 Physical Activity Readiness Questionnaire (PARQ+) 6

7 Research Design- Power Analysis alpha= 0.05 beta= 0.20 Sample of 96 subjects needed to achieve power Research Design Assessed for eligibility (n=140) Tested (n=137) Males (n=44) Females (n=93) Excluded (n=3) Ruled out by 2014 PARQ y.o. (n=71) y.o. (n=25) y.o. (n=19) y.o. (n=22) 7

8 Research Design Independent Variable Type of Test: 1. 6MWT 2. SCT Dependent Variable 1. Distance Walked on 6MWT 2. Ascent Time on SCT 3. Vitals (Heart Rate, Blood Pressure, Oxygen Saturation, Respiratory Rate, Self- Reported Dyspnea) Materials 1. Stopwatch 2. Chairs 3. Forms, including data sheet, consent form, dyspnea scale and PARQ+ 4. Electronic sphygmomanometer 5. Pulse oximeter 6. Telephone 7. Automated electronic defibrillator 8. Scale 9. Height tape 8

9 Protocol 6MWT Instructions Post 6MWT Pre SCT Post SCT Baseline 6MWT Performed SCT Instructions SCT Performed Six Minute Walk Test Specifics 9

10 Stair Climb Test Specifics Results and Discussion 10

11 Mean Test Results 6 Minute Walk Test Distance Walked (m) Stair Climb Test Time (s) Speed (m/s) Seconds/Step Total Sample: (+/ ) s (+/- 6.21) 0.45 (+/- 0.12) 0.36 (+/-.10) Analysis of Mean Test Results Moderate, positive correlation was found between distance walked in the 6MWT and ascent speed in the SCT for total sample (r= 0.54, p= 0.00, n= 137) 11

12 Statistical Analysis for Vitals Significant correlation was found between vitals post 6MWT and post SCT in all cases except Oxygen Saturation Moderate correlation for: HR: r=0.68,p=0.00 Dyspnea: r=0.67,p=0.00 RR: r=0.65,p=0.00 Systolic BP: r=0.58,p=0.00 Fair correlation for Diastolic BP: r = 0.49, p = 0.00 Little or no correlation for O 2 Saturation: r = 0.12, p = 0.17 Pre- and Post- Heart Rate Values HR pre 6MWT HR post 6MWT HR pre SCT HR post SCT Total Sample (+/ ) (+/ ) (+/ ) (+/ ) Significant difference between HR post 6MWT and HR Post SCT; t (₁₃₇) = 18.30, p =

13 Percent Change in Heart Rate Percent increase in HR: 6MWT: 39.76% SCT: 66.86% Percent change in HR from SCT significantly higher than percent change in HR from 6MWT Two-tailed t-test (t = 8.00, p = 0.00) Conclusions 13

14 Clinical Relevance Based on the consistent correlations between the two tests: The SCT may be a viable alternative to the 6MWT, but places higher cardiovascular demands on the individual The SCT may be useful in settings where the 6MWT cannot be performed due to either time or space constraints Ascending speed means can serve as normative values for clinical use Age Conclusions Normative Mean Values: Speed in m/s (95% Confidence Interval) Seconds/Step (95% Confidence Interval) (0.45 to 0.51) 0.34 (0.32 to 0.37) (0.46 to 0.54) 0.33 (0.30 to 0.36) (0.37 to 0.46) 0.40 (0.36 to 0.44) (0.33 to 0.41) 0.45 (0.40 to 0.50) Total Sample 0.45 (0.43 to 0.47) 0.36 (0.35 to 0.38) 14

15 Limitations Were unable to draw significant conclusions for age groups The overall sample size favored females Differences in motivation for subjects Definite conclusion cannot be drawn for different stairs or different populations Recommendations for Future Research Compare speed on various number of flights and number of steps to see how these factors impact speed and vitals Compare the Stair Climb Test to other functional outcome measures Larger number of participants for each age group and wider age range Include subjects with medical conditions Include testing descent time on stairs for a comprehensive ascent-descent Stair Climb Test 15

16 Questions? Contact Information: David Paek, SPT: BenWilkening, SPT: Delia Istrate, SPT: Sharlene Johnson, SPT: 16

17 References 1. Makary, M. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210(6): Afilalo J. Gait speed as an incremental predictor of mortality and major morbidity in elderly patient undergoing cardiac surgery. J Am Coll Cardio. 2010; 56(20); Hardy S. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007; 55 (11) Purser J. Walking speed predicts health status and hospital costs for frail elderly male veterans. J Rehabil Res Dev. 2005; 42 (4): Cesari M. Prognostic value of usual gait speed in well functioning older people - results from the health, aging and body composition study. J Am Geriatr Soc. 2005; 53 (10) Studenski S. Gait speed and survival in older adults. JAMA. 2010;305 (1): Wilken J, Darter BJ, Goffar SL, Ellwein JC, Snell RM, Tomalis EA, Shaffer SW, Physical Performance Assessment in Military Service Members. Journal of the American Academy of Orthopaedic Surgeons. 2012; 20 (1): S42-S47 8. Nightingale EJ, Pourkazemi F, Hiller CE. Systematic review of timed stair tests. Journal of rehabilitation research and development. 2014;51(3): Olsen GN, Bolton JW, Weiman DS, Hornung CA. Stair climbing as an exercise test to predict the postoperative complications of lung resection. Chest 1991;99(3): Van Nostrand D, Kjelsberg MO, Humphrey EW. Pre-resectional evaluation of risk from pneumonectomy. Surg Gynecol Obstet 1968; 127(2): Bohdan M Pichurko MD. Exercising Your Patient: Which Test(s) and When?. Respiratory Care. 2012; 57 (1) References 12. Ambrozin RPA, Cataneo DC, Arruda KA, Cataneo AJM, Time in the stair-climbing test as a predictor of thoracotomy postoperative complications. The American association for Thoracic Surgery. 2013; 145 (4): Wyzer C, Stulz P, Soler M, Tamm M, Muller- Brand J, Habicht J, et al. Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. Am J Respir Crit care Med, 1999; 159: Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118: Girish M, Trayner E Jr, Dammann O, Pinto-Plata V, Celli B. Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest. 2001;120: Cataneo D, Cataneo AJM. Accuracy of the stair-climbing test using maximal oxygen uptake as the gold standard. J Bras Pneumol. 2007;33: Cataneo DC, Kobayasi S, Carvalho LR, Paccanaro RC, Cataneo AJ. Accuracy of six minute walk test, stair test and spirometry using maximal oxygen uptake as gold standard. Acta Cir Bras. 2010;25: Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity- matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139: Brunelli A, Monteverde M, Al Refai M, Fianchini A. Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Ann Thorac Surg. 2004;77:

18 References 20. Brunelli A, Refai M, Xiume F, Salati M, Marasco R, Sciarra V, et al. Oxygen desaturation during maximal stair-climbing test and postoperative complications after major lung resections. Eur J Cardiothorac Surg. 2008;33: Koegelenberg C, Diacon A, Irani S. Stair climbing in the functional assessment of lung resection candidates. Respiration. 2008;75: Bernasconi M, Koegelenberg C, F, N, von Groote-Bidlingmaier F, Maree D, Barnard B, J, Diacon A, H, Bolliger C, T, Speed of Ascent During Stair Climbing Identifies Operable Lung Resection Candidates. Respiration 2012;84: Bean, J. F., Kiely, D. K., LaRose, S., Alian, J., & Frontera, W. R. (2007). Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults? Archives of Physical Medicine and Rehabilitation, 88(5), Roig, M., Eng, J. J., MacIntyre, D. L., Road, J. D., & Reid, W. D. (2010). Associations of the stair climb power test with muscle strength and functional performance in people with chronic obstructive pulmonary disease: a cross-sectional study. Physical Therapy, 90(12), Accessed July 06, Holden, D. A., Rice, T. W., Stelmach, K., & Meeker, D. P. (1992). Exercise Testing, 6-Min Walk, and Stair Climb in the Evaluation of Patients at High Risk for Pulmonary Resection. Chest, 102(6), Brunelli, A., Refai, M., Xiumé, F., Salati, M., Sciarra, V., Socci, L., & Sabbatini, A. (2008). Performance at Symptom-Limited Stair- Climbing Test is Associated With Increased Cardiopulmonary Complications, Mortality, and Costs After Major Lung Resection. The Annals of Thoracic Surgery, 86(1), Brunelli, A., Pompili, C., Berardi, R., Mazzanti, P., Onofri, A., Salati, M., Sabbatini, A. (2012). Performance at preoperative stairclimbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. The Annals of Thoracic Surgery, 93(6), Stair Climb Test Results 18

19 Six Minute Walk Test Results 6MWT Norms Comparison Authors and Publication # of Subjects 6MWT Distance Maria Raquel Soares, Carlos Alberto de Castro Pereira y.o Male 566 ± 87 m n= 66 Female 538 ± 95 m n= 66 Iwama, G.N. Andrade, P. Shima, S.E. Tanni, I. Godoy and V.Z. Dourado y.o 622 ± 80 m n = ± 71 m n= 73 AlfredoChettaa,, AndreaZaninib, GiovannaPisic,MarinaAielloa,PanagiotaTzania, MargheritaNerib, DarioOlivieria, y.o 638 ± 44 m n = ± 57 m n= 54 PAUL L. ENRIGHT and DUANE L. SHERRILL, y.o 576 m n= m n= 173 Sue Jenkins,, NolaCecins, BernadineCamarri, Crystal Williams, Philip, Thompson and Peter Eastwood, y.o 682 ± 73 m n= ± 70 m n= 61 Our total sample: (+/ ) meters (m) 19

20 Comparison of SCT in seconds/step Our results: Wilken, et al Nightingale, et al 20-29: 0.34(+/- 0.09) 30-39: 0.33 (+/- 0.06) 40-49: 0.40 (+/- 0.09) 50-60: 0.45 (+/- 0.10) Total sample: 0.36 (+/- 0.10) Males: 0.24 (+/- 0.03) Females: 0.26 (+/- 0.03) 18-49: 0.48 (+/- 0.14) 50-65: 0.46 (+/- 0.17) 65+: 0.65 (+/-.41) Modified Borg Dyspnea Scale o = Nothing at all 0.5 = Very, very slight (just noticeable) 1 = Very slight 2= Slight 3 = Moderate 4 = Somewhat severe 5 = Severe 6 = 7 = Very severe 8 = 9 = Very, very severe (almost maximal) 10 = Maximal 20

21 Dyspnea Age Dyspnea after 6MWT Dyspnea after SCT (+/- 1.38) 3.00 (+/- 1.54) (+/- 1.33) 3.20 (+/- 1.08) (+/- 1.29) 3.47 (+/- 1.46) (+/- 1.21) 3.52 (+/- 1.53) Total Sample 1.59 (+/- 1.33) 3.18 (+/- 1.45) Significant difference between Dyspnea post 6MWT and Dyspnea post SCT ; t (₁₃₇) = 16.29, p = 0.00 Age Mean Results for Tests 6 Minute Walk Test Distance Walked (m) Stair Climb Test Time (s) Speed (m/s) Seconds/Step (+/ ) s 0.51 (+/- 0.11) 0.34 (+/-.09) (n=71) (+/ ) s 0.51 (+/- 0.09) 0.33 (+/-.06) (n=25) (+/ ) s 0.43 (+/- 0.09) 0.40 (+/-.09) (n=19) (+/ ) s 0.38 (+/- 0.08) 0.45 (+/-.10) (n=22) Total Sample: (+/ ) s 0.45 (+/- 0.12) 0.36 (+/-.10) 21

22 Pre- and Post- Heart Rate Values Age HR pre 6MWT HR post 6MWT HR pre SCT HR post SCT (+/ ) (+/ ) (+/ ) (+/ ) (+/- 8.87) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) (+/ ) Total Sample (+/ ) (+/ ) (+/ ) (+/ ) Significant difference between HR post 6MWT and HR Post SCT; t (₁₃₇) = 18.30, p =