Triangulating Clinically Meaningful Change in the Six-minute Walk Test in Individuals with Chronic Heart Failure: A Systematic Review

Purpose

The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF).

Methods

The present review included two separate literature searches of the CINAHL and Medline databases for articles that: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves.

Results

Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40–45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI_95% .855, 1.015).

Conclusions

A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.Key Words: heart failure, six-minute walk test, clinically meaningful change, minimum detectable difference     

Peer education in the commons: a new approach to reference services

In planning for a new library construction project for the University of Oklahoma-Tulsa, graduate students enrolled in the University of Oklahoma (OU) School of Library and Information Studies collaborated in an innovative effort to develop a commons-based reference service. By first considering a philosophical approach to the need for a commons, blending in the experiences of other libraries that have created similar spaces, and focusing on the workflow issues likely to be encountered by the graduate assistants staffing the commons itself, this planning team developed an uncommon peer-to-peer approach to reference and education services, one focused on the patron as student.     

Doulas as community health workers: lessons learned from a volunteer program

Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers.     

Research summaries for normal birth

In this column, the author presents summaries of four research studies that further support the benefits of normal birth. The topics of the studies address cord clamping of term infants, the association of multiple cesareans and placental abnormalities, induction of labor at 41 weeks, and the World Health Organization's recently released pediatric growth charts.     

Understanding practitioners' characteristics and perspectives prior to the dissemination of an evidence-based intervention

OBJECTIVES: To describe the characteristics and repertoires of community practitioners serving families involved in child physical abuse that may inform training and treatment dissemination efforts. The aims are to: (a) describe the background characteristics of these clinicians; (b) document their most common intervention techniques; (c) examine clinicians' attitudes toward manualized treatment; and (d) understand the organizational climate of community agencies. METHOD: Practitioners from nine different agencies who have worked with cases in which there was child physical abuse (n=77) completed focus group discussions and three self-report questionnaires. Qualitative and quantitative analyses were conducted in tandem. RESULTS: Practitioners reported that they most often focused on family issues and employed family therapy techniques. Although treatment manuals were important, it was difficult to determine how practitioners used or would use these materials with families. An almost equal number of concerns and benefits were raised regarding using manuals in treatment. There was moderate agreement in how practitioners perceived their work environments. Age and attainment of a graduate degree were positively related to greater caring and job satisfaction, respectively, while length of time at a given agency was positively related to greater reports of emotional exhaustion on a measure of organizational climate. CONCLUSIONS: Given the promising benefits of evidence-based treatments for child abuse, it is important that researchers begin to form partnerships with community agencies that will lead to the dissemination and evaluation of effective treatment strategies.     

“Ferry Me O’er”: Musing on the Future of Museum Culture

Abstract Museum professionals face unprecedented challenges in the digital world of the twenty‐first century. How will we meet those challenges and who will lead us to the new shore of our future? We need museum professionals who act as ferrymen, guiding the museum community and its constituents through the troubled waters of our age to cultural reform that leads us to the essential purpose of art: love.     

Aligning digital and social inclusion: A study of disadvantaged students and computer access

In this paper we discuss the notion of the digital divide and link it with recent policy designed to promote social inclusion in a project that addressed both issues. Families in low socio economic areas of Australia were given computers and Internet access as part of a project that had as its primary aim to support the participation of disadvantaged families in digital activities at home and in schools. The authors collected data over a period of 3 years that included, pre and post surveys with parents and students, interviews with program facilitators, and focus groups with parents. This paper focuses on selected themes that emerged from the interview and focus group data with the parents and explores the ways in which they perceived having the computer had impacted on their lives and those of their school aged children. This data (surveys, interviews and focus groups) reveals that all family members felt that the ownership of a computer enabled them to feel more confident about their active participation in everyday educational, social and community activities. Parents, teachers and students also reported that owning a computer was important to their lives yet they were not naïve to the fact that they still had a lot to learn in terms of using all the options available to them on the computer. Students noted the increased ease with which they could complete school work and communicate with friends in online contexts and outlined some of the ways in which they used the computer for leisure activities. Parents highlighted the increase in their own digital skill levels and described the ways in which their lives had benefitted from having a computer in the home. Problems associated with connectivity at the beginning of the project, the quality of the machines and inadequate initial training were listed as drawbacks to greater participation. The project represents one attempt to address the digital divide and illustrates how going beyond the dichotomy of a ‘haves’ v ‘have nots’ view of the digital divide is necessary if we want to promote social inclusion.     

The role of materialism on social,emotional and behavioural difficulties for British adolescents

The relationship between materialism and social-emotional behavioural difficulties (SEBDs) was assessed by comparing a sample of adolescents receiving in-school behavioural support with adolescents not receiving any support. All participants completed the Youth Materialism Scale and the Strengths and Difficulties Questionnaire. Binary logistic regression indicated that adolescents who reported higher levels of materialism were more likely to be classified into a group considered ‘at-risk’ for developing conduct and peer problems. Hierarchical logistic regression assessed the moderation of behavioural support and indicated that adolescents in receipt of behavioural support who reported higher levels of materialism were at a greater risk of hyperactivity in comparison to those who receive support but reported lower levels of materialism. For adolescents not receiving behavioural support, less materialistic attitudes placed them at a greater risk of hyperactivity. These findings highlight the importance of distinguishing between different SEBD typologies and the potential effects of materialism during adolescence.