No retraction, correction or concern found when last checked on Nov 1, 2026.
The 6‐minute walk test and other clinical endpoints in duchenne muscular dystrophy: Reliability, concurrent validity, and minimal clinically important differences from a multicenter study
Craig M. McDonald, Erik K. Henricson, R. Ted Abresch and 10 more
Muscle & Nerve · 2013 · Randomised trial
Abstract
Introduction: An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6‐minute walk test (6MWT) and other endpoints. Methods: Screening and baseline evaluations included the 6‐minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate–determined energy expenditure index, and other exploratory endpoints. Results: The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. Conclusions: The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression. Muscle Nerve 48 : 357–368, 2013
Shown for reading. Its publisher allows quoting it, not republishing it.
References 78
- 1.
Hoffman EP, Brown RH, Kunkel LM. Dystrophin: the protein product of the Duchennemuscular dystrophy locus. Cell. 1987;51:919-928.
Not in our library10.1016/0092-8674(87)90579-4
- 2.
Mendell JR, Shilling C, Leslie ND, Flanigan KM, al-Dahhak R, Gastier-Foster J, et al. Evidence-based path to newborn screening for Duchenne muscular dystrophy. Ann Neurol. 2012;71:304-313.
Not in our library10.1002/ana.23528
- 3.
2009;58:1119-1122.
Not in our library
- 4.
Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol. 2010;9:77-93.
Not in our library10.1016/s1474-4422(09)70271-6
- 5.
Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol. 2010;9:177-189.
Not in our library10.1016/s1474-4422(09)70272-8
- 6.
Dent KM, Dunn DM, von Niederhausern AC, Aoyagi AT, Kerr L, Bromberg MB, et al. Improved molecular diagnosis of dystrophinopathies in an unselected clinical cohort. Am J Med Genet A. 2005;134:295-298.
Not in our library10.1002/ajmg.a.30617
- 7.
Hirawat S, Elfring GL, Leonard EM.
Not in our library
- 8.
Hirawat S, Elfring GL, Leonard EM.
Not in our library
- 9.
Chamberlain JS, Rando TA. Duchenne muscular dystrophy: advances in therapeutics. 2006.
Not in our library
- 10.
Welch EM, Barton ER, Zhuo J, Tomizawa Y, Friesen WJ, Trifillis P, et al. PTC124 targets genetic disorders caused by nonsense mutations. Nature. 2007;447:87-91.
Not in our library10.1038/nature05756
- 11.
Goemans NM, Tulinius M, van den Akker JT, Burm BE, Ekhart PF, Heuvelmans N, et al. Systemic administration of PRO051 in Duchenne's muscular dystrophy. N Engl J Med. 2011;364:1513-1522.
Not in our library10.1056/nejmoa1011367
- 12.
- 13.
Crespo CJ, Keteyian SJ, Heath GW, Sempos CT. Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 1996;156:93-98.
Not in our library
- 14.
Brooke MH, Fenichel GM, Griggs RC, Mendell JR, Moxley R, Florence J, et al. Duchenne muscular dystrophy: patterns of clinical progression and effects of supportive therapy. Neurology. 1989;39:475-481.
Not in our library10.1212/wnl.39.4.475
- 15.
McDonald CM, Fowler WM. The role of the neuromuscular medicine and physiatry specialists in the multidisciplinary management of neuromuscular disease. Phys Med Rehabil Clin N Am. 2012;23:475-493.
Not in our library10.1016/j.pmr.2012.06.010
- 16.
McDonald CM, Abresch RT, Carter GT, Fowler WM, Johnson ER, Kilmer DD, et al. Profiles of neuromuscular diseases. Duchenne muscular dystrophy. Am J Phys Med Rehabil. 1995;74(suppl):S70-92.
Not in our library10.1097/00002060-199509001-00003
- 17.
Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.
Not in our library10.1164/ajrccm.166.1.at1102
- 18.
Takeuchi Y, Katsuno M, Banno H, Suzuki K, Kawashima M, Atsuta N, et al. Walking capacity evaluated by the 6-minute walk test in spinal and bulbar muscular atrophy. Muscle Nerve. 2008;38:964-971.
Not in our library10.1002/mus.21077
- 19.
Rubin LJ, Badesch DB, Barst RJ, Galie N, Black CM, Keogh A, et al. Bosentan therapy for pulmonary arterial hypertension. N Engl J Med. 2002;346:896-903.
Not in our library10.1056/nejmoa012212
- 20.
Dumas HM, Fragala MA, Haley SM, Skrinar AM, Wraith JE, Cox GF. Physical performance testing in mucopolysaccharidosis I: a pilot study. Pediatr Rehabil. 2004;7:125-131.
Not in our library10.1080/13638490310001654763
- 21.
Muenzer J, Wraith JE, Beck M, Giugliani R, Harmatz P, Eng CM, et al. A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome). Genet Med. 2006;8:465-473.
Not in our library10.1097/01.gim.0000232477.37660.fb
- 22.
Muenzer J, Gucsavas-Calikoglu M, McCandless SE, Schuetz TJ, Kimura A. A phase I/II clinical trial of enzyme replacement therapy in mucopolysaccharidosis II (Hunter syndrome). Mol Genet Metab. 2007;90:329-337.
Not in our library10.1016/j.ymgme.2006.09.001
- 23.
Harmatz P, Giugliani R, Schwartz, Guffon N, Teles EL, Miranda MC, et al. Long-term follow-up of endurance and safety outcomes during enzyme replacement therapy for mucopolysaccharidosis VI: Final results of three clinical studies of recombinant human N-acetylgalactosamine 4-sulfatase. Mol Genet Metab. 2008;94:469-475.
Not in our library10.1016/j.ymgme.2008.04.001
- 24.
Wraith JE, Clarke LA, Beck M, Kolodny EH, Pastores GM, Muenzer J, et al. Enzyme replacement therapy for mucopolysaccharidosis I: a randomized, double-blinded, placebo-controlled, multinational study of recombinant human alpha-L-iduronidase (laronidase). J Pediatr. 2004;144:581-588.
Not in our library10.1016/j.jpeds.2004.01.046
- 25.
van der Ploeg AT, Clemens PR, Corzo D, Escolar DM, Florence J, Groeneveld GJ, et al. A randomized study of alglucosidase alfa in late-onset Pompe's disease. N Engl J Med. 2010;362:1396-1406.
Not in our library10.1056/nejmoa0909859
- 26.
McDonald CM, Henricson EK, Han JJ, Abresch RT, Nicorici A, Elfring GL, et al. The 6-minute walk test as a new outcome measure in Duchenne muscular dystrophy. Muscle Nerve. 2010;41:500-510.
Not in our library10.1002/mus.21544
- 27.
McDonald CM, Henricson EK, Han JJ, Abresch RT, Nicorici A, Atkinson L, et al. The 6-minute walk test in Duchenne/Becker muscular dystrophy: longitudinal observations. Muscle Nerve. 2010;42:966-974.
Not in our library10.1002/mus.21808
- 28.
Mazzone E, Martinelli D, Berardinelli A, Messina S, D'Amico A, Vasco G, et al. North Star Ambulatory Assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy. Neuromuscul Disord. 2010;20:712-716.
Not in our library10.1016/j.nmd.2010.06.014
- 29.
Mazzone E, Vasco G, Sormani MP, Torrente Y, Berardinelli A, Messina S, et al. Functional changes in Duchenne muscular dystrophy: a 12-month longitudinal cohort study. Neurology. 2011;77:250-256.
Not in our library10.1212/wnl.0b013e318225ab2e
- 30.
Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407-415.
Not in our library10.1016/0197-2456(89)90005-6
- 31.
Beaton DE, Bombardier C, Katz JN, Wright JG, Wells G, Boers M, et al. Looking for important change/differences in studies of responsiveness. OMERACT MCID Working Group. Outcome measures in rheumatology. Minimal clinically important difference. J Rheumatol. 2001;28:400-405.
Not in our library
- 32.
- 33.
Hays RD, Woolley JM. The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Pharmacoeconomics. 2000;18:419-423.
Not in our library10.2165/00019053-200018050-00001
- 34.
Wells G, Anderson J, Beaton D, Bellamy N, Boers M, Bombardier C, et al. Minimal clinically important difference module: summary, recommendations, and research agenda. J Rheumatol. 2001;28:452-454.
Not in our library
- 35.
Jacobson N, Follette WC, Revenstorf D. Toward a standard definition of clinically significant change. Behav Ther. 1986;17:308-311.
Not in our library
- 36.
Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003;56:395-407.
Not in our library10.1016/s0895-4356(03)00044-1
- 37.
Crosby RD, Kolotkin RL, Williams GR. An integrated method to determine meaningful changes in health-related quality of life. J Clin Epidemiol. 2004;57:1153-1160.
Not in our library10.1016/j.jclinepi.2004.04.004
- 38.
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59:12-19.
Not in our library10.1037//0022-006x.59.1.12
- 39.
Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials. 1991;12(suppl):142S-158S.
Not in our library10.1016/s0197-2456(05)80019-4
- 40.
Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance. J Chronic Dis. 1986;39:897-906.
Not in our library10.1016/0021-9681(86)90038-x
- 41.
Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care. 1999;37:469-478.
Not in our library10.1097/00005650-199905000-00006
- 42.
Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27(suppl):S178-189.
Not in our library10.1097/00005650-198903001-00015
- 43.
Yost KJ, Eton DT. Combining distribution- and anchor-based approaches to determine minimally important differences: the FACIT experience. Eval Health Prof. 2005;28:172-191.
Not in our library10.1177/0163278705275340
- 44.
Beaton DE, Boers M, Wells GA. Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol. 2002;14:109-114.
Not in our library10.1097/00002281-200203000-00006
- 45.
Brooke MH, Griggs RC, Mendell JR, Fenichel GM, Shumate JB, Pellegrino RJ. Clinical trial in Duchenne dystrophy. I. The design of the protocol. Muscle Nerve. 1981;4:186-197.
Not in our library10.1002/mus.880040304
- 46.
Brooke MH, Fenichel GM, Griggs RC, Mendell JR, Moxley R, Miller JP, et al. Clinical investigation in Duchenne dystrophy: 2. Determination of the “power” of therapeutic trials based on the natural history. Muscle Nerve. 1983;6:91-103.
Not in our library10.1002/mus.880060204
- 47.
Mendell JR, Moxley RT, Griggs RC, Brooke MH, Fenichel GM, Miller JP, et al. Randomized, double-blind six-month trial of prednisone in Duchenne's muscular dystrophy. N Engl J Med. 1989;320:1592-1597.
Not in our library10.1056/nejm198906153202405
- 48.
Griggs RC, Moxley RT, Mendell JR, Fenichel GM, Brooke MH, Pestronk A, et al. Prednisone in Duchenne dystrophy. A randomized, controlled trial defining the time course and dose response. Clinical Investigation of Duchenne Dystrophy Group. Arch Neurol. 1991;48:383-388.
Not in our library10.1001/archneur.1991.00530160047012
- 49.
Fowler WM, Abresch RT, Aitkens S, Carter GT, Johnson ER, Kilmer DD, et al. Profiles of neuromuscular diseases. Design of the protocol. Am J Phys Med Rehabil. 1995;74:S62-69.
Not in our library10.1097/00002060-199509001-00002
- 50.
Beenakker EA, Fock JM, van Tol MJ, Maurits NM, Koopman HM, Brouwer OF, et al. Intermittent prednisone therapy in Duchenne muscular dystrophy: a randomized controlled trial. Arch Neurol. 2005;62:128-132.
Not in our library10.1001/archneur.62.1.128
- 51.
Pradhan S, Ghosh D, Srivastava NK, Kumar A, Mittal B, Pandey CM, et al. Prednisolone in Duchenne muscular dystrophy with imminent loss of ambulation. J Neurol. 2006;253:1309-1316.
Not in our library10.1007/s00415-006-0212-1
- 52.
McDonald CM, Henricson EK, Abresch RT, Han JJ, Escolar DM, Florence JM, et al. The CINRG Duchenne Natural History Study—a longitudinal natural history study in the era of glucocorticoid therapy: design of the protocol and methods. Muscle Nerve. 2013;48:32-54.
Not in our library10.1002/mus.23807
- 53.
Beenakker EA, van der Hoeven JH, Fock JM, Maurits NM. Reference values of maximum isometric muscle force obtained in 270 children aged 4–16 years by hand-held dynamometry. Neuromuscul Disord. 2001;11:441-446.
Not in our library10.1016/s0960-8966(01)00193-6
- 54.
Hyde SA, Steffensen BF, Floytrup I, et al. Longitudinal data analysis: an application to construction of a natural history profile of Duchenne muscular dystrophy. Neuromuscul Disord. 2001;11:165-170.
Not in our library10.1016/s0960-8966(00)00175-9
- 55.
Stuberg WA, Metcalf WK. Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer. Phys Ther. 1988;68:977-982.
Not in our library10.1093/ptj/68.6.977
- 56.
Brussock CM, Haley SM, Munsat TL, Bernhardt DB. Measurement of isometric force in children with and without Duchenne's muscular dystrophy. Phys Ther. 1992;72:105-114.
Not in our library10.1093/ptj/72.2.105
- 57.
Varni JW, Seid M, Kurtin PS. PedsQL™ 4.0: reliability and validity of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales in healthy and patient populations. Med Care. 2001;39:800-812.
Not in our library10.1097/00005650-200108000-00006
- 58.
Varni JW, Seid M, Knight TS, Uzark K, Szer IS. The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. J Behav Med. 2002;25:175-193.
Not in our library10.1023/a:1014836921812
- 59.
Varni JWBT, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3:329-341.
Not in our library10.1367/1539-4409(2003)003<0329:tpaapp>2.0.co;2
- 60.
- 61.
McDonald CM, McDonald DA, Bagley A, Sienko ThomasS, Buckon CE, Henricson E, et al. Relationship between clinical outcome measures and parent proxy reports of health-related quality of life in ambulatory children with Duchenne muscular dystrophy. J Child Neurol. 2010;25:1130-1144.
Not in our library10.1177/0883073810371509
- 62.
Henricson E, Abresch R, Han JJ, Nicorici A, Goude KellerE, Elfring G, et al. Percent-predicted 6-minute walk distance in Duchenne muscular dystrophy to account for maturational influences. PLoS Curr. 2012;4:RRN1297.
Not in our library10.1371/currents.rrn1297
- 63.
Geiger R, Strasak A, Treml B, Gasser K, Kleinsasser A, Fischer V, et al. Six-minute walk test in children and adolescents. J Pediatr. 2007;150:395-399.
Not in our library10.1016/j.jpeds.2006.12.052
- 64.
Rose J, Medeiros JM, Parker R. Energy cost index as an estimate of energy expenditure of cerebral-palsied children during assisted ambulation. Dev Med Child Neurol. 1985;27:485-490.
Not in our library10.1111/j.1469-8749.1985.tb04572.x
- 65.
Rose J, Gamble JG, Medeiros J, Burgos A, Haskell WL. Energy cost of walking in normal children and in those with cerebral palsy: comparison of heart rate and oxygen uptake. J Pediatr Orthop. 1989;9:276-279.
Not in our library
- 66.
Rose J, Gamble JG, Burgos A, Medeiros J, Haskell WL. Energy expenditure index of walking for normal children and for children with cerebral palsy. Dev Med Child Neurol. 1990;32:333-340.
Not in our library10.1111/j.1469-8749.1990.tb16945.x
- 67.
Rose J, Gamble JG, Lee J, Lee R, Haskell WL. The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents. J Pediatr Orthop. 1991;11:571-578.
Not in our library
- 68.
Rose J, Haskell WL, Gamble JG, Hamilton RL, Brown DA, Rinsky L. Muscle pathology and clinical measures of disability in children with cerebral palsy. J Orthop Res. 1994;12:758-768.
Not in our library10.1002/jor.1100120603
- 69.
Beenakker EA, Maurits NM, Fock JM, Brouwer OF, van der Hoeven JH. Functional ability and muscle force in healthy children and ambulant Duchenne muscular dystrophy patients. Eur J Paediatr Neurol. 2005;9:387-393.
Not in our library10.1016/j.ejpn.2005.06.004
- 70.
Henricson EK, Abresch RT, Han JJ, Nicorici A, Goude E, de Bie E, McDonald CM.
Not in our library10.1371/currents.md.9e17658b007eb79fcd6f723089f79e06
- 71.
Ong EKMC, Walsh DD, Widman L, Walsh SA, Abresch RT, McDonald CM. Energy cost of locomotion in boys with Duchenne muscular dystrophy measured with a portable metabolic cart. Devel Med Child Neurol. 1999;41:34.
Not in our library
- 72.
Sienko Thomas S, Buckon CE, Nicorici A, Bagley A, McDonald CM, Sussman MD. Classification of the gait patterns of boys with Duchenne muscular dystrophy and their relationship to function. J Child Neurol. 2010;25:1103-1109.
Not in our library10.1177/0883073810371002
- 73.
Jansen M, de Jong M, Coes HM, Eggermont F, van Alfen N, de Groot IJM. The assisted 6-minute cycling test to assess endurance in children with a neuromuscular disorder. Muscle Nerve. 2012;46:520-530.
Not in our library10.1002/mus.23369
- 74.
Du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, et al. Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Am J Respir Crit Care Med. 2011;183:1231-1237.
Not in our library10.1164/rccm.201007-1179oc
- 75.
Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Small changes in six-minute walk distance are important in diffuse parenchymal lung disease. Respir Med. 2009;103:1430-1435.
Not in our library10.1016/j.rmed.2009.04.024
- 76.
Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schünemann HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J. 2008;32:637-643.
Not in our library10.1183/09031936.00140507
- 77.
Gremeaux V, Troisgros O, Benaïm S, Hannequin A, Laurent Y, Casillas JM, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. 2011;92:611-619.
Not in our library10.1016/j.apmr.2010.11.023
- 78.
Cited by papers we hold 3
- Bayesian modeling and simulation to inform rare disease drug development early decision-making: Application to Duchenne muscular dystrophy. · 2022Not checked
- Preliminary Evidences of Safety and Efficacy of Flavonoids- and Omega 3-Based Compound for Muscular Dystrophies Treatment: A Randomized Double-Blind Placebo Controlled Pilot Clinical Trial · 2019Not checked
- THE 6‐minute walk test and other endpoints in Duchenne muscular dystrophy: Longitudinal natural history observations over 48 weeks from a multicenter study · 2013No notice
Reads
Read by people on this page
None yet.
Checked or read by AI through naulon
None yet.
A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.
Are you an author?
Is this your paper?
Claim it to add your note and be paid when agents cite it. Free.