Advertisement

The Utility of the 2-Minute Walk Test as a Measure of Mobility in People With Lower Limb Amputation

Published:April 06, 2020DOI:https://doi.org/10.1016/j.apmr.2020.03.007

      Abstract

      Objectives

      To establish reference values for the 2-minute walk test (2-MWT) distance and gait speed in people with a lower limb amputation (LLA) who are prosthetic ambulators. Also, to describe the differences in distance and gait speed between sexes, causes of amputation, levels of amputation, health risk classification, functional levels, and age groups.

      Design

      Cross-sectional study.

      Setting

      National meeting for people with lower limb amputation.

      Participants

      A convenience sample of unilateral people (N=101; 47 men, 54 women; mean age ± SD, 50.9±14.3 y) with an LLA; 48 had a transtibial amputation and 53 had a transfemoral amputation. Participants were classified as either limited community ambulators, community ambulators, or those who exceed basic ambulation skills (K2, n=7; K3, n=70; K4, n=24).

      Intervention

      Not applicable.

      Main Outcome Measure

      2-MWT performance (ie, distance and gait speed).

      Results

      The mean ± SD 2-MWT distance and gait speed for the entire sample was 143.8±37.5 meters (range, 49-259 m) and 72.1±18.8 meters per minute (range, 25-130 m/min), respectively. Men walked farther (distance: men, 154.2±34.2 m; women, 134.4±38.1 m) and faster (gait speed: men, 77.3±17.1 m/min; women, 67.4±19.1 m/min) than women (P<.05). The mean ± SD 2-MWT distance for K4, K3, and K2 level participants was 177.9±31.1 meters, 138.4±28.5 meters, and 81.7±26.9 meters, respectively. Functional level K4 participants performed better than K3 participants (P<.05), and K3 participants performed better than K2 participants (P<.05). People with transtibial amputation walked farther than those with transfemoral amputation (152.9±43.0 m vs 135.6±43.0 m) (P<.05). The distance and speed ambulated by those participants classified in the very high health risk group was worse than those categorized as being at an increased high health risk group (P<.05) and the no increase health risk group (P<.05). The performance of participants older than 70 years old was inferior to the performance of all younger age groups.

      Conclusions

      Reference values for the 2-MWT distance and gait speed were established in people with LLA who are prosthetic ambulators. Significant differences in the 2-MWT performance were found between sexes, causes of amputation, levels of amputation, health risk classification, functional levels, and age groups.

      Keywords

      List of abbreviations:

      2-MWT (2-minute walk test), 6-MWT (6-minute walk test), 12-MWT (12-minute walk test), ANOVA (analysis of variance), BMI (body mass index), LLA (lower limb amputation), MFCL (Medicare Functional Classification Level), PT (physical therapist), TTA (transtibial amputation), TFA (transfemoral amputation), WtHR (waist-to-height ratio)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ziegler-Graham K.
        • MacKenzie E.J.
        • Ephraim P.L.
        • Travison T.G.
        • Brookmeyer R.
        Estimating the prevalence of limb loss in the United States: 2005 to 2050.
        Arch Phys Med Rehabil. 2008; 89: 422-429
        • Fortington L.V.
        • Rommers G.M.
        • Geertzen J.H.
        • Postema K.
        • Dijkstra P.U.
        Mobility in elderly people with a lower limb amputation: a systematic review.
        J Am Med Dir Assoc. 2012; 13: 319-325
        • Christiansen C.L.
        • Fields T.
        • Lev G.
        • Stephenson R.O.
        • Stevens-Lapsley J.E.
        Functional outcomes after the prosthetic training phase of rehabilitation after dysvascular lower extremity amputation.
        PM R. 2015; 7: 1118-1126
        • Agrawal M.
        • Kalra A.S.
        • Joshi M.
        Correlation of ambulation potential with quality of life in lower limb amputees.
        Int J Community Med Public Health. 2017; 4: 4259-4265
        • Frykberg R.G.
        • Arora S.
        • Pomposelli Jr., F.B.
        • LoGerfo F.
        Functional outcome in the elderly following lower extremity amputation.
        J Foot Ankle Surg. 1998; 37: 181-185
        • Cooper K.H.
        A means of assessing maximal oxygen intake. Correlation between field and treadmill testing.
        JAMA. 1968; 203: 201-204
        • McGavin C.R.
        • Gupta S.P.
        • McHardy G.J.
        Twelve-minute walking test for assessing disability in chronic bronchitis.
        Br Med J. 1976; 1: 822-823
        • Mungall I.P.F.
        • Hainsworth R.
        Assessment of respiratory function in patients with chronic airways disease.
        Thorax. 1979; 34: 254-258
        • Butland R.J.
        • Pang J.
        • Gross E.R.
        • Woodcock A.A.
        • Geddes D.M.
        Two-, six-, and 12-minute walking tests in respiratory disease.
        Br Med J (Clin Res Ed). 1982; 284: 1607-1608
        • Brooks D.
        • Hunter J.P.
        • Parsons J.
        • Livsey E.
        • Quirt J.
        • Devlin M.
        Reliability of the two-minute walk test in individuals with transtibial amputation.
        Arch Phys Med Rehabil. 2002; 83: 1562-1565
        • Frlan-Vrgoc L.
        • Vrbanić T.S.
        • Kraguljac D.
        • Kovacević M.
        Functional outcome assessment of lower limb amputees and prosthetic users with a 2-minute walk test.
        Coll Antropol. 2011; 35: 1215-1218
        • Miller W.C.
        • Deathe A.B.
        • Speechley M.
        Psychometric properties of the Activities-specific Balance Confidence Scale among individuals with a lower-limb amputation.
        Arch Phys Med Rehabil. 2003; 84: 656-661
        • Meikle B.
        • Boulias C.
        • Pauley T.
        • Devlin M.
        Does increased prosthetic weight affect gait speed and patient preference in dysvascular transfemoral amputees?.
        Arch Phys Med Rehabil. 2003; 84: 1657-1661
        • Resnik L.
        • Borgia M.
        Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error.
        Phys Ther. 2011; 91: 555-565
        • Gremeaux V.
        • Damak S.
        • Troisgros O.
        • et al.
        Selecting a test for the clinical assessment of balance and walking capacity at the definitive fitting state after unilateral amputation: a comparative study.
        Prosthet Orthot Int. 2012; 36: 415-422
        • Swanson C.W.
        • Haigh Z.J.
        • Fling B.W.
        Two-minute walk tests demonstrate similar age-related gait differences as a six-minute walk test.
        Gait Posture. 2019; 69: 36-39
        • Reid L.
        • Thomson P.
        • Besemann M.
        • Dudek N.
        Going places: Does the two-minute walk test predict the six-minute walk test in lower extremity amputees?.
        J Rehabil Med. 2015; 47: 256-261
        • Lean M.E.
        • Han T.S.
        • Morrison C.E.
        Waist circumference as a measure for indicating need for weight management.
        BMJ. 1995; 311: 158-161
        • Gailey R.S.
        • Gaunaurd I.A.
        • Agrawal V.
        • Finnieston A.
        • O’Toole C.
        • Tolchin R.
        Application of self-report and performance-based outcome measures to determine functional differences between four categories of prosthetic feet.
        J Rehab Res Dev. 2012; 49: 597-612
        • Linberg A.
        • Roach K.
        • Campbell S.
        • Stoneman P.
        • Gaunaurd I.A.
        • Gomez-Orozco C.
        • Raya M.A.
        • Gailey R.S.
        Comparison of six-minute walk test performance between non-amputee active duty soldiers and service members with traumatic lower limb loss.
        J Rehab Res Dev. 2013; 50: 931-940
        • Bohannon R.W.
        • Wang Y.C.
        • Gershon R.C.
        Two-minute walk test performance by adults 18 to 85 years: normative values, reliability, and responsiveness.
        Arch Phys Med Rehabil. 2015; 96: 472-477
        • Brooks D.
        • Parsons J.
        • Hunter J.P.
        • Devlin M.
        • Walker J.
        The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation.
        Arch Phys Med Rehabil. 2001; 82: 1478-1483
        • Bohannon R.W.
        • Andrews A.W.
        Normal walking speed: a descriptive meta-analysis.
        Physiotherapy. 2011; 97: 182-189
        • Ashwell M.
        • Gibson S.
        Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference.
        BMJ Open. 2016; 6: 1-7
        • Mozumdar A.
        • Roy S.K.
        Method for estimating body weight in persons with lower-limb amputation and its implication for their nutritional assessment.
        Am J Clin Nutr. 2004; 80: 868-875
        • Gailey R.S.
        • Roach K.E.
        • Applegate E.B.
        • et al.
        The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate.
        Arch Phys Med Rehabil. 2002; 83: 613-627
        • Batten H.R.
        • McPhail S.M.
        • Mandrusiak A.M.
        • Varghese P.N.
        • Kuys S.S.
        Gait speed as an indicator of prosthetic walking potential following lower limb amputation.
        Prosthet Orthot Int. 2019; 43: 196-203
        • Browning R.C.
        • Baker E.A.
        • Herron J.A.
        • Kram R.
        Effects of obesity and sex on the energetic cost and preferred speed of walking.
        J Appl Physiol. 2006; 100: 390-398
        • Mohler B.J.
        • Thompson W.B.
        • Creem-Regehr S.H.
        • Pick Jr., H.L.
        • Warren Jr., W.H.
        Visual flow influences gait transition speed and preferred walking speed.
        Exp Brain Res. 2007; 181: 221-228
        • Smidt G.L.
        Gait in rehabilitation.
        Churchill Livingstone, New York1990: 6