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The estimates were externally validated using the Pulmonary Hypertension Association Registry. We anchored the change in 6MWD to the change in the Medical Outcomes Survey Short Form physical component score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The derivation (clinical trial) and validation (Pulmonary Hypertension Association Registry) samples were comprised of 2,404 and 537 adult patients with PAH, respectively. The mean\u2009\u00b1\u2009standard deviation age of the derivation sample was 50.5\u2009\u00b1\u200915.2 years, and 1,849 (77%) were female, similar to the validation sample. The minimal clinically important difference in the derivation sample was 33 meters (95% confidence interval, 27\u201338), which was almost identical to that in the validation sample (36 m [95% confidence interval, 29\u201343]). The minimal clinically important difference did not differ by age, sex, race, pulmonary hypertension etiology, body mass index, use of background therapy, or World Health Organization functional class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We estimated a 6MWD minimal clinically important difference of approximately 33 meters for adults with PAH. Our findings can be applied to the design of clinical trials of therapies for PAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202208-1547oc","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T10:07:53Z","timestamp":1673431673000},"page":"1070-1079","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":73,"title":["Minimal Clinically Important Difference in the 6-minute-walk Distance for Patients with Pulmonary Arterial Hypertension"],"prefix":"10.1093","volume":"207","author":[{"given":"Jude","family":"Moutchia","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn L.","family":"McClelland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Al-Naamani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina H.","family":"Appleby","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Blank","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Grinnan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Mathai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7864-6096","authenticated-orcid":false,"given":"Jasleen","family":"Minhas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey E.","family":"Ventetuolo","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Health Services, Policy and Practice, Brown University, Providence, Rhode Island; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roham T.","family":"Zamanian","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Kawut","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics and"},{"name":"Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,15]]},"reference":[{"key":"2026012204490566700_bib1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1378\/chest.15-0300","article-title":"Five-year outcomes of patients enrolled in the REVEAL registry","volume":"148","author":"Farber","year":"2015","journal-title":"Chest"},{"key":"2026012204490566700_bib2","doi-asserted-by":"crossref","first-page":"1801908","DOI":"10.1183\/13993003.01908-2018","article-title":"Clinical trial design and new therapies for pulmonary arterial hypertension","volume":"53","author":"Sitbon","year":"2019","journal-title":"Eur Respir J"},{"key":"2026012204490566700_bib3","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1161\/CIRCULATIONAHA.112.105890","article-title":"Validation of 6-minute walk distance as a surrogate end point in pulmonary arterial hypertension trials","volume":"126","author":"Gabler","year":"2012","journal-title":"Circulation"},{"key":"2026012204490566700_bib4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/0197-2456(89)90005-6","article-title":"Measurement of health status. 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