Remotely Administered Walking Tests for Assessing Functional Capacity in Patients with Chronic Pulmonary Diseases or...

Objective: The objective of this study is to conduct a systematic review of the evidence on the use of remotely administered walking tests (RaWTs) in patients with chronic pulmonary diseases (CPDs) and heart failure (HF), focusing on agreement, reliability, feasibility, and clinical utility as outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD420251180996). The PubMed, Web of Science, CENTRAL, Scopus, and ACM databases were comprehensively searched from inception up to October 2025. Observational, randomized and non-randomized control studies assessing the agreement, reliability, feasibility, and clinical utility of RaWTs in people with CPDs and HF and reporting quantitative outcomes were eligible. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the COSMIN Risk of Bias tool for the reliability studies, the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized studies, and the Quality in Prognosis Studies (QUIPS) tool for the prognostic studies. Results: Eleven studies met the inclusion criteria. Five studies included patients with HF, five with pulmonary hypertension (PH), and one study included candidates for lung transplantation due to advanced CPD. All studies used the 6 min walk test (6MWT); one also included the incremental shuttle walk test. Agreement with face-to-face in-clinic testing (in five studies) is setting-dependent and influenced by the testing setup. Reliability (in eight studies), derived from variable statistical indices in both patient populations, showed that RaWTs are reliable. Adherence and safety were used as the main feasibility indicators. Eight studies concluded that remote assessment is feasible, acceptable, and safe. Clinical utility was examined in only one HF study, showing that remotely administered 6MWT can predict all-cause mortality and HF hospitalization. According to COSMIN, the overall methodological quality of nine studies ranged from very good to inadequate. One study was rated as having a serious risk of bias according to ROBINS-I, and one study as having a high risk of bias according to QUIPS. Conclusions: Although the evidence is limited and heterogeneous, RaWTs demonstrate robust reliability across repeated measurements while agreement with in-clinic testing is context-dependent and strongly influenced by test setup and environmental conditions. RaWTs appear to be acceptable to patients; however, further high-quality studies are needed to confirm these findings and determine the clinical utility of RaWTs on specific clinical outcomes in these populations.