Unsupervised Functional Capacity Testing at Home: A Systematic Review

BACKGROUND: Physical functioning is closely linked to disability and mortality in older people. An important aspect of physical functioning is functional capacity, which can be measured with wearable technology. It is, however, unclear which tests can be completed using wearable technology and what the clinimetric properties of such measurements are. The objective was to systematically review home-based functional capacity tests and their clinimetric properties in people with a chronic disease. METHODS: PubMed and CINAHL were used to find relevant articles. Clinical trials studying clinimetric properties including people with any type of cancer, chronic cardiovascular, pulmonary, or neurological disorder or people undergoing elective surgery were included in this review. Additionally, studies using an unsupervised or remotely supervised home-based functional capacity test were included. Information on clinimetric properties was extracted by two independent raters using the COSMIN guidelines. Relevant information was registered. RESULTS: We included 29 articles, studying the 6-Minute Walk Test (6MWT) (n = 19), the Timed-Up-and-Go (n = 6), the 30 s Sit-To-Stand test (n = 2) and the step test (n = 2). The 6MWT with a smartphone-based application showed acceptable results for validity and reliability. For most other approaches, there was limited information available on clinimetric properties. CONCLUSIONS: This review shows that at home testing of functional capacity is feasible, although evidence on its clinimetric properties remains limited. The 6MWT has been studied most widely, showing acceptable results when performing the test using smartphone applications in people with chronic diseases. Further research is needed before these tests can be widely applied in both research and clinical care.