6MWT

A patient with Idiopathic Pulmonary Hypertension was admitted to the hospital respiratory ward for further investigation due to ‘failure’ of achieving the targeted distance in her most recent 6MWT, as was told by the clinical physiotherapist. She expressed her disappointment during my subjective assessment, as it was explained to her that she has to ‘pass’ the 6MWT before she could be prescribed a specific medication that could prolong her lifespan. In other words, if she fails the 6MWT again she would not be given the medication. She had also stated that her right patella was removed and the knee joint was fused secondary to OA. This meant that she was not able to flex her knee during ambulation and would thus slow her walking speed. To complicate the matter, she had acquired LRTI in the hospital.

As she had not been out of bed on my initial session with her and her Obs and BP were stable, I decided that ambulation was the most appropriate intervention. I observed that she became quite SOB after about 10m of ambulation, so I asked if she wanted to sit down. (Her SpO2 was within normal limits) She declined and said “it’s alright, I can do this.” As we resumed, I realised that her SOB had increased progressively but the patient did not want to stop until she walked back to her bed (20m). Nonetheless, she recovered in about 2-3 minutes with relaxed breathing and other coping strategies to reduce her SOB.

On hindsight, I realised that the likely reason for the patient being so determined to keep walking despite mod-severe breathlessness was her perception that if she kept walking she would eventually be able to ‘pass’ her 6MWT (which was to be performed in a week). As a clinician, I should have insisted the patient to stop and rest to avoid any unforeseen circumstances. The following day, I ensured the patient understood that the 6MWT was not about passing or failing. It was to determine her functional and cardiopulmonary status and whether she was able to adequately manage her SOB. I also assured her that her speed limitation secondary to the fused knee would be taken into consideration.