Pembacaan Jurnal International Journal of COPD 2016:11 657–663

14 Juni 2016
Aep Saepudin

Six-minute stepper test: a valid clinical exercise tolerance test for COPD
patients
Grosbois JM, Riquier C, Chehere B, Coquart J, Behal H, Bart F, et al

Uji toleransi latihan merupakan bagian integral dari tatalaksana rehabilitasi

paru pada pasien penyakit paru obstruktif (PPOK). The 6-minute stepper test
(6MST) adalah uji latihan yang baru, dapat ditolensi dengan baik, mudah
dilakukan, dan dapat dilakukan tanpa ada keterbatasan ruangan. Tujuan dari
penelitian ini adalah membandingkan hasil 6MST terhadap hasil 6-minute walk
test (6MWT) dan cardiopulmonary exercise testing (CPET) pada pasien PPOK.
Pada penelitian ini 91 pasien PPOK di bagian rawat jalan yang menjalani
rehabilitasi paru dinilai dengan menggunakan 6MST, 6MWT, dan CPET
dimasukkan kedalam penelitian secara retrospektif. Korelasi antara jumlah
langkah dalam 6MST, jarak yang dicapai pada 6MWT, konsumsi oksigen dan
kekuatan pada ambang ventilasi (the ventilatory threshold) dan upaya maksimum
selama CPET di analisis sebelum menjalani rehabillitasi paru dan perbaikan pada
6MST dan 6MWT dibandingkan setelah rehabilitasi paru.
Dari hasil penelitian didapatkan bahwa jumlah langkah pada 6MST
berkorelasi secara signifikan dengan jarak tempuh pada 6MWT (r=0.56;
P,0.0001), kekuatan pada upaya maksimum (maximum effort) (r=0.46; P,0.0001),
dan konsumsi oksigen pada upaya maksimum (r=0.39; P,0.005). Kinerja pada
6MST dan 6MWT meningkat signifikan setelah rehabilitasi paru (570 vs 488
steps, P=0.001 and 448 vs 406 m, secara berurutan; P,0.0001). Perbaikan pada
6MST dan 6MWT setelah rehabilitasi paru berkorelasi secara signifikan (r=0.34;
P=0.03).
Penelitian ini menunjukan bahwa didapatkan korelasi yang signifikan antara
jumlah langkah pada 6MST dengan jarak tempuh pada 6MWT, VO 2 max, dan
kekuatan ventilatory threshold (VT) dan upaya maksimum (maximum effort),
tidak bergantung pada derajat berat PPOK. Hasil penelitian ini mengindikasikan
bahwa 6MST dapat digunakan secara luas pada berbagai derajat penyakit paru
kronik.
Kesimpulan dari penelitian ini adalah 6MST merupakan alat uji yang valid
untuk mengevaluasi toleransi latihan pada pasien PPOK. Menggunakan 6MST
pada praktek klinis sangat relevan untuk penilaian pada pasien-pasien yang
menjalani rehabillitasi paru.
 CRITICAL APPRAISAL
 Are the results of the study valid?
- Did the study address a clearly focused issue?
Yes, the study address a clearly focused issue about exercise tolerance test
for COPD patients using the 6 minute stepper test (6MST).
- Did the authors use an appropriate methode to answer their question?
Yes, the study use retrospective methode. COPD patients managed by
outpatient PR and assessed by 6MST, 6MWT, and CPET were
retrospectively included in this study.
- Were the subjects recruited in an acceptable way?
Yes, Patients included in this study were those who had completed the
entire PR program and those for whom pre-rehabilitation 6MWT, 6MST,
and CPET assessment data were available. All data were collected
prospectively and were entered into rehabilitation computerized medical
records.
- Were the measures accurately measured to reduce bias?
Yes, All tests were initially performed on the overall population, and then
according to the severity of COPD exclusively for the 6MST and 6MWT
results . The severity of COPD was evaluated by Global Initiative for
Chronic Obstructive Lung Disease (GOLD) stage.
- Were the data collected in a way that addressed the research issue?
Yes, All data were collected prospectively and were entered into our
rehabilitation computerized medical records. The study protocol was
approved by the Observational Research Protocol Evaluation Committee
of the French Language Society of Pulmonology, France.
- Did the study have enough participants to minimize the play of chance?
Yes, this study had enough participants. Ninety-one COPD patients
managed by outpatient PR and assessed by 6MST, 6MWT, and CPET
were retrospectively included in this study
The study is Valid

 What are the results?

- How are the results presented and what is the main result?
The number of steps on the 6MST was significantly correlated with the
distance covered on the 6MWT (r=0.56; P,0.0001), the power at
maximum effort (r=0.46; P,0.0001), and oxygen consumption at
maximum effort (r=0.39; P,0.005). Performances on the 6MST and
6MWT were significantly improved after PR (570 vs 488 steps, P=0.001
and 448 vs 406 m, respectively; P,0.0001). Improvements of the 6MST
and 6MWT after PR were significantly correlated (r=0.34; P=0.03).
- Was the data analysis sufficiently rigorous?
Yes, statistical analysis was performed with PRISM software and SAS
version 9.3 software. Pearson’s or Spearman’s correlation coefficient was
used to evaluate the correlation between the results of the various tests
performed by the patients (CPET, 6MWT, and 6MST). Student’s t-test for
paired data or Wilcoxon signed rank test was used to compare the course
 of the 6MST and 6MWT results before and after PR, according to the
distribution of the variables
- Is there a clear statement of findings?
Yes, This study shows that the number of steps on the 6MST was
significantly correlated with the distance covered on the 6MWT, Vo2 max,
and power at VT and at maximum effort, independent of the severity of
COPD. These results also show a significant correlation between
improvements of performances on the 6MWT and 6MST after outpatient
PR.
The study is important

 Will the results help locally?

- Can the results be applied to the local population?
Yes, it can be applied to our local population
- How valuable is the research?
This research is valuable, all of these results indicate that the 6MST can be
used in a wide range of patients with varying degrees of severity of
chronic lung disease.
The Study is applicable