Journal article
App-based versus standard six-minute walk test in pulmonary hypertension: mixed methods study
- Abstract:
- Background: Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary vasculature that can lead to heart failure and premature death. Assessment of patients with PAH includes performing a 6-minute walk test (6MWT) in clinics. We developed a smartphone app to compute the walked distance (6MWD) indoors, by counting U-turns, and outdoors, by using satellite positioning. Objective: The goal of the research was to assess (1) accuracy of the indoor 6MWTs in clinical settings, (2) validity and test-retest reliability of outdoor 6MWTs in the community, (3) compliance, usability, and acceptance of the app, and (4) feasibility of pulse oximetry during 6MWTs. Methods: We tested the app on 30 PAH patients over 6 months. Patients were asked to perform 3 conventional 6MWTs in clinic while using the app in the indoor mode and one or more app-based 6MWTs in outdoor mode in the community per month. Results: Bland-Altman analysis of 70 pairs of conventional versus app-based indoor 6MWDs suggests that the app is sometimes inaccurate (14.6 m mean difference, lower and upper limit of agreement: –133.35 m to 162.55 m). The comparison of 69 pairs of conventional 6MWDs and community-based outdoor 6MWDs within 7 days shows that community tests are strongly related to those performed in clinic (correlation 0.89), but the interpretation of the distance should consider that differences above the clinically significant threshold are not uncommon. Analysis of 89 pairs of outdoor tests performed by the same patient within 7 days shows that community-based tests are repeatable (intraclass correlation 0.91, standard error of measurement 36.97 m, mean coefficient of variation 12.45%). Questionnaires and semistructured interviews indicate that the app is usable and well accepted, but motivation to use it could be affected if the data are not used for clinical decision, which may explain low compliance in 52% of our cohort. Analysis of pulse oximetry data indicates that conventional pulse oximeters are unreliable if used during a walk. Conclusions: App-based outdoor 6MWTs in community settings are valid, repeatable, and well accepted by patients. More studies would be needed to assess the benefits of using the app in clinical practice. Trial Registration: ClinicalTrials.gov NCT04633538; https://clinicaltrials.gov/ct2/show/NCT04633538
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, pdf, 841.3KB, Terms of use)
-
- Publisher copy:
- 10.2196/22748
Authors
- Publisher:
- JMIR Publications
- Journal:
- JMIR mHealth and uHealth More from this journal
- Volume:
- 9
- Issue:
- 6
- Article number:
- e22748
- Publication date:
- 2021-06-07
- Acceptance date:
- 2021-04-08
- DOI:
- EISSN:
-
2291-5222
- Pmid:
-
34096876
- Language:
-
English
- Keywords:
- Pubs id:
-
1181647
- Local pid:
-
pubs:1181647
- Deposit date:
-
2022-12-20
Terms of use
- Copyright holder:
- Salvi et al.
- Copyright date:
- 2021
- Rights statement:
- ©Dario Salvi, Emma Poffley, Lionel Tarassenko, Elizabeth Orchard. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 07.06.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.
- Licence:
- CC Attribution (CC BY)
If you are the owner of this record, you can report an update to it here: Report update to this record