Results from clinical field tests to evaluate cardiorespiratory fitness in psoriatic arthritis patients. > **Quote:** > > * * * > > Objective: > Cardiorespiratory fitness (CRF) is reduced in patients with psoriatic arthritis (PsA), highlighting the need for a consistent assessment of CRF in clinical practice. This study aimed to examine the associations between outcomes of clinical field tests, namely six-minute walk test (6MWT) and handgrip strength (HGS), and CRF, as well as to evaluate the accuracy of these clinical field tests in detecting impaired CRF in patients with PsA. > > Methods: > Distance walked during 6WMT (six-minute walk distance [6MWD]), HGS by hand dynamometry, and maximal CRF as peak oxygen uptake (VO2peak, milliliters per minute per kilogram) by cardiopulmonary exercise testing were assessed. 6MWD and HGS were compared to reference charts of the general population using one-sided t-tests. Spearman rank correlation coefficients (rs), multivariable linear regression models, and receiver operating curves were analyzed to study associations. > > Results: > In 80 patients with PsA, 6MWD was strongly associated with VO2peak (rS = 0.65, P < 0.001), with the multivariable linear regression model, consisting of 6MWD and 6MWT heart rate response and adjusted for relevant covariates, explaining 70% of variance in VO2peak. The threshold of 108% predicted 6MWD had sensitivity of 75% and specificity of 64% to identify patients with impaired CRF. 6MWD and HGS were not significantly decreased compared to the general population (P > 0.05). A higher 6MWD was moderately to strongly correlated with more favorable outcomes regarding disease activity, cardiometabolic risk, and patient-reported outcomes. No or only weak associations between HGS and VO2peak as well as clinical outcomes were noted. > > Conclusion: > 6MWD was strongly associated with VO2peak, was moderately to strongly correlated with important clinical outcomes, and had adequate accuracy to detect patients with impaired CRF. > Source: onlinelibrary.wiley.com *Funding: Fonds voor Wetenschappelijk ReumaOnderzoek/Fonds pour la Recherche Scientifique en Rhumatologie’ and 'Klinisch Onderzoek en Opleidingsfonds of UZ Leuven

Background Cardiorespiratory fitness (CRF) is reduced in patients with psoriatic arthritis (PsA), highlighting the need for a consistent assessment of CRF in clinical practice. This study aimed to e...

This connects directly to something I posted yesterday: Randomisation in the Wild Part 4: The Permutation Test Nobody Ran The short version: I went back to the eteplirsen trial (12 patients, 3 arms) and ran the permutation test that Fisher’s framework prescribes, but that the one nobody ran at the time. The published MMRM found no significant 6MWT difference (p ≈ 0.56 for 50 mg/kg vs placebo). The exact permutation test over all C(8,4) = 70 possible allocations returns p = 0.029 for the same comparison, and p = 0.005 for the mITT population (excluding the two patients who lost ambulation). Same data. Same patients. Same outcome. Same timepoint. A 20-fold difference in p-values, entirely attributable to whether the analysis uses the randomisation or a parametric model with more parameters than the data can support. The sensitivity analysis is mixed, and I’m transparent about that in the post. The mITT finding is robust across 1,000 plausible individual patient allocations (90% below p = 0.05, median p = 0.019). The 50 mg/kg comparison is more nuanced (median p = 0.086, ~25% below 0.05 at the strict threshold). But in no plausible allocation does the permutation test return anything near 0.56. The MMRM result was an artefact of the parametric machinery, not a description of the data. The broader point for this thread: the Gossett-Fisher dispute about the validity of t-tests for non-random (balanced/minimized) experiments may be less practically important than it appears, because wherever the randomisation was actually performed, the permutation test is available and assumption-free. The question isn’t whether the t-distribution is appropriate for thin-tailed data from balanced designs. It’s whether anyone reaches for the tool that requires no distributional assumptions at all.

evidenceinthewild: > The published MMRM found no significant 6MWT difference This relates to a broader question, assuming MMRM implies the use of random intercepts. For frequentist models, it may not be the case that being parametric is the problem; it may instead be the case that the sampling distributions being approximated by the frequentist approach are just not good enough, i.e., p-values and confidence intervals are not always accurate.

Heart failure (HF) is a major cause of hospitalization, and exercise capacity is a key prognostic marker. The six-minute walk test (6MWT) is widely used to assess exercise capacity, but six-minute walk distance (6MWD) varies among individuals, especially the elderly. This study aimed to assess the hypothesis that Δ-Ex, the average oxygen desaturation during the 6MWT, could enhance the prognostic value of 6MWD in elderly patients with HF for cardiovascular risk prediction. In this single-center, prospective observational study, 55 patients aged ≥65 yr with acute HF were evaluated before discharge. Patients were divided into small and large Δ-Ex groups and short and long 6MWD groups based on cutoff values of 6.7% and 220 m, respectively, obtained from the receiver operating characteristics curve analysis. Patients were followed up for 1 yr to assess major adverse cardiovascular events, including rehospitalization for heart failure or cardiovascular death. The mean Δ-Ex was 5.8 ± 4.3%, and the mean 6MWD was 237.5 ± 106.7 m. Patients with large Δ-Ex had significantly higher event rates [hazard ratio (HR) = 6.66; P < 0.001], whereas those with short 6MWD had HR of 2.40 (P = 0.03). Combining Δ-Ex with 6MWD improved predictive accuracy [area under the curve (AUC) = 0.78] compared with either marker alone (AUC = 0.72 for Δ-Ex and 0.62 for 6MWD). Importantly, patients with both large Δ-Ex and short 6MWD had the highest event rates, indicating the additive prognostic value of combining both markers. In conclusion, Δ-Ex is a complementary marker to 6MWD, improving risk stratification in elderly patients with HF. NEW & NOTEWORTHY This study evaluates the use of Δ-Ex, measured during the six-minute walk test (6MWT), as a complementary prognostic marker to the six-minute walk distance (6MWD) in elderly patients with heart failure. We hypothesize that combining Δ-Ex with 6MWD will improve the predictive accuracy for cardiovascular outcomes, offering a practical, noninvasive method for risk stratification and enhancing clinical decision-making for this patient population.