The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study

Abstract

Background/objective: To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.

Methods: Translation was performed from the original English instruction via the recommended "Process of translation and adaptation of instruments" by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.

Results: Intraclass correlation coefficient for inter-rater reliability was excellent ( $\text{ICC}=0.999$ , 95% confidence $\text{interval}=0.996$ -1.000). Similarly, the intra-rater reliability across the three raters was high (R1: $\text{ICC}=0.996$ , 95% confidence interval $(\text{CI})=0.812$ -1.000; R2: $\text{ICC}=1.000$ , 95% $\text{CI}=0.994$ -1.000; R3: $\text{ICC}=1.000$ , 95% $\text{CI}=0.998$ -1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption ( $r=0.315$ , $p=0.023$ ; $r=0.309$ , $p=0.026$ ).

Conclusion: This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.

Keywords: Chinese translation; Six-minute walk test; exercise test; outcome measures; validation.