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VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION

Year 2020, Volume: 31 Issue: 2, 210 - 217, 28.08.2020
https://doi.org/10.21653/tjpr.714503

Abstract

Purpose: This study aimed to investigate the psychometric properties of the 6-minute pegboard ring test (6PBRT) in patients with pulmonary hypertension (PH).
Methods: This study included 31 patients with PH. The upper extremity function was measured with the 6PBRT. Muscle strength was measured for shoulder flexor, shoulder abductor, elbow extensor, and elbow flexors muscles using with a digital dynamometer, and handgrip strength with the hand dynamometer. Limitation of the activities of daily living was evaluated with the Milliken Activities of Daily Living Scale. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability.
Results: The 6PBRT showed excellent test-retest reliability with the ICC=0.98 (95% CI: 0.82–0.99). The SEM and MDC were calculated as 5.9 and 16.4, respectively. The patients with NYHA Class III had significantly lower scores in the 6PBRT compared to the patients with Class II (p=0.005) showing the known-groups validity of the 6PBRT. The 6PBRT was significantly and strongly correlated with age (r=-0.628, p<0.001), functional class (r=-0.502, p=0.004), activities of daily living (r=0.522, p=0.003), moderately correlated with shoulder flexor (r=0.360, p=0.047), shoulder abductor (r=0.388, p=0.031), elbow flexor (r=0.406, p=0.036) and handgrip muscles strength (r=0.375, p=0.041).
Conclusion: This study showed that the 6PBRT has excellent test-retest reliability and good validity, including known-groups and convergent in PH. The higher 6PBRT scores were significantly correlated with younger age, better functional class and performance in activities of daily living, and greater upper extremity muscle strength.

Supporting Institution

None

Thanks

We would like to express our sincere thanks to Turhan Kahraman, PhD, PT from the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Katip Çelebi University, Izmir, Turkey, for statistical help.

References

  • 1. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42-50.
  • 2. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67-119.
  • 3. Breda AP, Pereira de Albuquerque AL, Jardim C, Morinaga LK, Suesada MM, Fernandes CJ, et al. Skeletal muscle abnormalities in pulmonary arterial hypertension. PLoS One. 2014;9(12):e114101.
  • 4. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax. 2010;65(2):113-7.
  • 5. Demir R, Küçükoğlu MS. Six-minute walk test in pulmonary arterial hypertension. Anatol J Cardiol. 2015;15(3):249-54.
  • 6. Poms AD, Turner M, Farber HW, Meltzer LA, McGoon MD. Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis. Chest. 2013;144(1):169-76.
  • 7. Bellet RN, Francis RL, Jacob JS, Healy KM, Bartlett HJ, Adams L, et al. Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Arch Phys Med Rehabil. 2011;92(9):1388-94.
  • 8. Saglam M, Vardar-Yagli N, Calik-Kutukcu E, Arikan H, Savci S, Inal-Ince D, et al. Functional exercise capacity, physical activity, and respiratory and peripheral muscle strength in pulmonary hypertension according to disease severity. J Phys Ther Sci. 2015;27(5):1309-12.
  • 9. Ozcan Kahraman B, Ozsoy I, Acar S, Ozpelit E, Akdeniz B, Sevinc C, et al. [Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension]. Turk Kardiyol Dern Ars. 2017;45(5):434-40.
  • 10. Pendleton HM, Schultz-Krohn W. Pedretti's occupational therapy-e-book: practice skills for physical dysfunction: Elsevier Health Sciences; 2017.
  • 11. McCollister D, Shaffer S, Badesch DB, Filusch A, Hunsche E, Schuler R, et al. Development of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT(R)) questionnaire: a new patient-reported outcome instrument for PAH. Respir Res. 2016;17(1):72.
  • 12. Lima VP, Almeida FD, Janaudis-Ferreira T, Carmona B, Ribeiro-Samora GA, Velloso M. Reference values for the six-minute pegboard and ring test in healthy adults in Brazil. J Bras Pneumol. 2018;44:190-4.
  • 13. Celli BR, Rassulo J, Make BJ. Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction. N Engl J Med. 1986;314(23):1485-90.
  • 14. Zhan S, Cerny FJ, Gibbons WJ, Mador MJ, Wu YW. Development of an unsupported arm exercise test in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2006;26(3):180-7; discussion 8-90.
  • 15. Felisberto RM, de Barros CF, Nucci KCA, de Albuquerque ALP, Paulin E, de Brito CMM, et al. Is the 6-minute pegboard and ring test valid to evaluate upper limb function in hospitalized patients with acute exacerbation of COPD? Int J Chron Obstruct Pulmon Dis. 2018;13:1663-73.
  • 16. Kahraman BO, Savci S, Ozsoy I, Baran A, Acar S, Ozpelit E, et al. Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study. J Cardiol. 2020.
  • 17. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009;34(6):1219-63.
  • 18. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, et al. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S55-66.
  • 19. Ozsoy I, Kahraman BO, Ozsoy G, Ilcin N, Kahraman T, Acar S, et al. Determinants of the 6-minute pegboard and ring test as an unsupported upper-extremity exercise capacity measure in older adults with chronic obstructive pulmonary disease. Eur Geriatr Med. 2018;9(6):863-70.
  • 20. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res. 2007;39(2):175-91.
  • 21. Shoukri M, Asyali M, Donner A. Sample size requirements for the design of reliability study: review and new results. Stat Methods Med Res. 2004;13(4):251-71.
  • 22. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
  • 23. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997;78(1):26-32.
  • 24. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76(3):248-59.
  • 25. Haidar SG, Kumar D, Bassi RS, Deshmukh SC. Average versus maximum grip strength: which is more consistent? J Hand Surg Br. 2004;29(1):82-4.
  • 26. Akel BS, Oksuz C, Kayihan H. Adaptation and validation of Turkish version of the Milliken ADL Scale (MAS). J Hand Ther. 2010;23(4):e12.
  • 27. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155-63.
  • 28. Cohen J. Statistical Power Analysis for the Behavioral Sciences, (L. Erlbaum Associates, Hillsdale, NJ). Erlbaum Associates Hillsdale, NJ.; 1988.
  • 29. Lima VP, Almeida FD, Janaudis-Ferreira T, Carmona B, Ribeiro-Samora GA, Velloso M. Reference values for the six-minute pegboard and ring test in healthy adults in Brazil. J Bras Pneumol. 2018;44(3):190-4.
  • 30. Lima VP, Brooks D, Konidis S, Araújo T, Ribeiro-Samora GA, Goldstein R, et al. Normative Values for the Unsupported Upper Limb Exercise Test and 6-Minute Pegboard and Ring Test in Healthy Canadian Adults. Physiother Can.0(0):e20190021.
  • 31. Lima VP, Velloso M, Almeida FD, Carmona B, Ribeiro-Samora GA, Janaudis-Ferreira T. Test-retest reliability of the unsupported upper-limb exercise test (UULEX) and 6-min peg board ring test (6PBRT) in healthy adult individuals. Physiother Theory Pract. 2018;34(10):806-12.
  • 32. von der Heyde R, Droege K. 8 - Assessment of Functional Outcomes. In: Cooper C, editor. Fundamentals of Hand Therapy (Second Edition). St. Louis: Mosby; 2014. p. 115-27.
  • 33. Calik-Kutukcu E, Arikan H, Vardar-Yagli N, Saglam M, Inal-Ince D, Oksuz C, et al. Association between 6min pegboard and ring test and arm performance in GOLD stage II-III patients. Wien Klin Wochenschr. 2020.
  • 34. Nyberg A, Tornberg A, Wadell K. Correlation between Limb Muscle Endurance, Strength, and Functional Capacity in People with Chronic Obstructive Pulmonary Disease. Physiother Can. 2016;68(1):46-53.
  • 35. Janaudis-Ferreira T, Hill K, Goldstein RS, Wadell K, Brooks D. Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease. Physiother Can. 2013;65(1):40-3.
  • 36. Wong AY, Kawchuk G, Parent E, Prasad N. Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain. Man Ther. 2013;18(5):395-402.

VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION

Year 2020, Volume: 31 Issue: 2, 210 - 217, 28.08.2020
https://doi.org/10.21653/tjpr.714503

Abstract

Amaç: Bu çalışmada amacımız pulmoner hipertansiyonlu (PH) hastalarda 6-dakika pegboard ring testinin (6PBRT) psikometrik özelliklerinin araştırılmasıydı.
Yöntem: Bu çalışmaya 31 PH hastası dahil edildi. Üst ekstremite fonksiyonu 6PBRT ile ölçüldü. Kas kuvveti için dijital dinamometre ile omuz fleksör, omuz abdüktör, dirsek ekstansör ve dirsek fleksör kasları ve el dinamometresi ile kavrama kuvveti ölçülmüştür. Günlük yaşam aktivitelerinin limitasyonu Milliken Günlük Yaşam Aktiviteleri Ölçeği ile değerlendirildi. Test-tekrar test güvenilirliğini belirlemek için sınıf içi korelasyon katsayısı (ICC) kullanıldı.
Sonuçlar: 6PBRT için ICC değeri 0,98 (95% CI: 0,82–0,99) idi. SEM ve MDC değerleri sırasıyla 5,9 ve 16,4 olarak hesaplandı. 6PBRT bilinen grupların geçerliliğini gösterdi ve NYHA Sınıf III olan hastalar 6PBRT'de Sınıf II hastalara göre anlamlı derecede düşük skorlara sahipti (p=0,005). 6PBRT yaş (r=-0,628, p<0,001), fonksiyonel sınıf (r=-0,502, p=0,004), günlük yaşam aktiviteleri (r=-0,502, p=0,004) ile güçlü, omuz fleksörü (r=0,360, p=0,047), omuz abdüksiyonu (r=0,388, p=0,031) ile dirsek fleksörü (r=0,406, p=0,036) ve kavrama kuvveti (r=0,375, p=0,041) anlamlı ve orta korelasyon gösterdi.
Tartışma: Bu çalışma PH’da 6PBRT'nin mükemmel bir test-tekrar test güvenilirliğine ve bilinen gruplar ve yakınsak dahil iyi geçerliliğe sahip olduğunu göstermiştir. Yüksek 6PBRT skorları daha genç yaş, daha iyi fonksiyonel sınıf ve günlük yaşam aktivitelerinde performans ve üst ekstremite kas kuvveti ile anlamlı derecede korele idi.

References

  • 1. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42-50.
  • 2. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67-119.
  • 3. Breda AP, Pereira de Albuquerque AL, Jardim C, Morinaga LK, Suesada MM, Fernandes CJ, et al. Skeletal muscle abnormalities in pulmonary arterial hypertension. PLoS One. 2014;9(12):e114101.
  • 4. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax. 2010;65(2):113-7.
  • 5. Demir R, Küçükoğlu MS. Six-minute walk test in pulmonary arterial hypertension. Anatol J Cardiol. 2015;15(3):249-54.
  • 6. Poms AD, Turner M, Farber HW, Meltzer LA, McGoon MD. Comorbid conditions and outcomes in patients with pulmonary arterial hypertension: a REVEAL registry analysis. Chest. 2013;144(1):169-76.
  • 7. Bellet RN, Francis RL, Jacob JS, Healy KM, Bartlett HJ, Adams L, et al. Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Arch Phys Med Rehabil. 2011;92(9):1388-94.
  • 8. Saglam M, Vardar-Yagli N, Calik-Kutukcu E, Arikan H, Savci S, Inal-Ince D, et al. Functional exercise capacity, physical activity, and respiratory and peripheral muscle strength in pulmonary hypertension according to disease severity. J Phys Ther Sci. 2015;27(5):1309-12.
  • 9. Ozcan Kahraman B, Ozsoy I, Acar S, Ozpelit E, Akdeniz B, Sevinc C, et al. [Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension]. Turk Kardiyol Dern Ars. 2017;45(5):434-40.
  • 10. Pendleton HM, Schultz-Krohn W. Pedretti's occupational therapy-e-book: practice skills for physical dysfunction: Elsevier Health Sciences; 2017.
  • 11. McCollister D, Shaffer S, Badesch DB, Filusch A, Hunsche E, Schuler R, et al. Development of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT(R)) questionnaire: a new patient-reported outcome instrument for PAH. Respir Res. 2016;17(1):72.
  • 12. Lima VP, Almeida FD, Janaudis-Ferreira T, Carmona B, Ribeiro-Samora GA, Velloso M. Reference values for the six-minute pegboard and ring test in healthy adults in Brazil. J Bras Pneumol. 2018;44:190-4.
  • 13. Celli BR, Rassulo J, Make BJ. Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction. N Engl J Med. 1986;314(23):1485-90.
  • 14. Zhan S, Cerny FJ, Gibbons WJ, Mador MJ, Wu YW. Development of an unsupported arm exercise test in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2006;26(3):180-7; discussion 8-90.
  • 15. Felisberto RM, de Barros CF, Nucci KCA, de Albuquerque ALP, Paulin E, de Brito CMM, et al. Is the 6-minute pegboard and ring test valid to evaluate upper limb function in hospitalized patients with acute exacerbation of COPD? Int J Chron Obstruct Pulmon Dis. 2018;13:1663-73.
  • 16. Kahraman BO, Savci S, Ozsoy I, Baran A, Acar S, Ozpelit E, et al. Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study. J Cardiol. 2020.
  • 17. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009;34(6):1219-63.
  • 18. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, et al. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S55-66.
  • 19. Ozsoy I, Kahraman BO, Ozsoy G, Ilcin N, Kahraman T, Acar S, et al. Determinants of the 6-minute pegboard and ring test as an unsupported upper-extremity exercise capacity measure in older adults with chronic obstructive pulmonary disease. Eur Geriatr Med. 2018;9(6):863-70.
  • 20. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res. 2007;39(2):175-91.
  • 21. Shoukri M, Asyali M, Donner A. Sample size requirements for the design of reliability study: review and new results. Stat Methods Med Res. 2004;13(4):251-71.
  • 22. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
  • 23. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil. 1997;78(1):26-32.
  • 24. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76(3):248-59.
  • 25. Haidar SG, Kumar D, Bassi RS, Deshmukh SC. Average versus maximum grip strength: which is more consistent? J Hand Surg Br. 2004;29(1):82-4.
  • 26. Akel BS, Oksuz C, Kayihan H. Adaptation and validation of Turkish version of the Milliken ADL Scale (MAS). J Hand Ther. 2010;23(4):e12.
  • 27. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155-63.
  • 28. Cohen J. Statistical Power Analysis for the Behavioral Sciences, (L. Erlbaum Associates, Hillsdale, NJ). Erlbaum Associates Hillsdale, NJ.; 1988.
  • 29. Lima VP, Almeida FD, Janaudis-Ferreira T, Carmona B, Ribeiro-Samora GA, Velloso M. Reference values for the six-minute pegboard and ring test in healthy adults in Brazil. J Bras Pneumol. 2018;44(3):190-4.
  • 30. Lima VP, Brooks D, Konidis S, Araújo T, Ribeiro-Samora GA, Goldstein R, et al. Normative Values for the Unsupported Upper Limb Exercise Test and 6-Minute Pegboard and Ring Test in Healthy Canadian Adults. Physiother Can.0(0):e20190021.
  • 31. Lima VP, Velloso M, Almeida FD, Carmona B, Ribeiro-Samora GA, Janaudis-Ferreira T. Test-retest reliability of the unsupported upper-limb exercise test (UULEX) and 6-min peg board ring test (6PBRT) in healthy adult individuals. Physiother Theory Pract. 2018;34(10):806-12.
  • 32. von der Heyde R, Droege K. 8 - Assessment of Functional Outcomes. In: Cooper C, editor. Fundamentals of Hand Therapy (Second Edition). St. Louis: Mosby; 2014. p. 115-27.
  • 33. Calik-Kutukcu E, Arikan H, Vardar-Yagli N, Saglam M, Inal-Ince D, Oksuz C, et al. Association between 6min pegboard and ring test and arm performance in GOLD stage II-III patients. Wien Klin Wochenschr. 2020.
  • 34. Nyberg A, Tornberg A, Wadell K. Correlation between Limb Muscle Endurance, Strength, and Functional Capacity in People with Chronic Obstructive Pulmonary Disease. Physiother Can. 2016;68(1):46-53.
  • 35. Janaudis-Ferreira T, Hill K, Goldstein RS, Wadell K, Brooks D. Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease. Physiother Can. 2013;65(1):40-3.
  • 36. Wong AY, Kawchuk G, Parent E, Prasad N. Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain. Man Ther. 2013;18(5):395-402.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Araştırma Makaleleri
Authors

Buse Özcan Kahraman 0000-0002-0192-6740

İsmail Özsoy 0000-0001-9048-1116

Aylin Tanrıverdi 0000-0002-0220-0642

Bahri Akdeniz This is me 0000-0003-4854-8035

Ebru Özpelit This is me 0000-0002-9766-9717

Bihter Şentürk 0000-0003-3568-4476

Serap Acar This is me 0000-0001-8226-1543

Can Sevinç This is me 0000-0003-3691-9150

Sema Savcı 0000-0001-8675-1937

Publication Date August 28, 2020
Published in Issue Year 2020 Volume: 31 Issue: 2

Cite

APA Özcan Kahraman, B., Özsoy, İ., Tanrıverdi, A., Akdeniz, B., et al. (2020). VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, 31(2), 210-217. https://doi.org/10.21653/tjpr.714503
AMA Özcan Kahraman B, Özsoy İ, Tanrıverdi A, Akdeniz B, Özpelit E, Şentürk B, Acar S, Sevinç C, Savcı S. VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION. Turk J Physiother Rehabil. August 2020;31(2):210-217. doi:10.21653/tjpr.714503
Chicago Özcan Kahraman, Buse, İsmail Özsoy, Aylin Tanrıverdi, Bahri Akdeniz, Ebru Özpelit, Bihter Şentürk, Serap Acar, Can Sevinç, and Sema Savcı. “VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi 31, no. 2 (August 2020): 210-17. https://doi.org/10.21653/tjpr.714503.
EndNote Özcan Kahraman B, Özsoy İ, Tanrıverdi A, Akdeniz B, Özpelit E, Şentürk B, Acar S, Sevinç C, Savcı S (August 1, 2020) VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION. Türk Fizyoterapi ve Rehabilitasyon Dergisi 31 2 210–217.
IEEE B. Özcan Kahraman, “VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION”, Turk J Physiother Rehabil, vol. 31, no. 2, pp. 210–217, 2020, doi: 10.21653/tjpr.714503.
ISNAD Özcan Kahraman, Buse et al. “VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION”. Türk Fizyoterapi ve Rehabilitasyon Dergisi 31/2 (August 2020), 210-217. https://doi.org/10.21653/tjpr.714503.
JAMA Özcan Kahraman B, Özsoy İ, Tanrıverdi A, Akdeniz B, Özpelit E, Şentürk B, Acar S, Sevinç C, Savcı S. VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION. Turk J Physiother Rehabil. 2020;31:210–217.
MLA Özcan Kahraman, Buse et al. “VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION”. Türk Fizyoterapi Ve Rehabilitasyon Dergisi, vol. 31, no. 2, 2020, pp. 210-7, doi:10.21653/tjpr.714503.
Vancouver Özcan Kahraman B, Özsoy İ, Tanrıverdi A, Akdeniz B, Özpelit E, Şentürk B, Acar S, Sevinç C, Savcı S. VALIDITY AND RELIABILITY OF THE 6-MINUTE PEGBOARD RING TEST IN PATIENTS WITH PULMONARY HYPERTENSION. Turk J Physiother Rehabil. 2020;31(2):210-7.