Commentary on “Validity of the Early Activity Scale for Endurance and the 6-Minute Walk Test for Children With Cerebral Palsy”

Abstract

“How should I apply this information?” This study provides descriptive and validity data for the Early Activity Scale for Endurance (EASE) in a cohort of children with cerebral palsy (CP) and highlights the importance of endurance for overall physical activity and participation in meaningful daily activities. The EASE is a useful tool for discussion with parents regarding their children's endurance during daily activities. This offers a clinical advantage over a capacity measure such as the 6-minute walk test (6MWT) or other complicated laboratory-based tools. The EASE is designed to capture endurance information for young children and those with limited or no walking, which may increase its clinical utility. Younger participants had lower EASE scores (lower endurance capacity) as well as shorter 6MWT distances, which could be meaningful to better understand endurance trends in CP. “What should I be mindful about when applying this information?” Therapists should consider the study age range (<12 years) and clinical population (only CP). The EASE is designed for use with children at all Gross Motor Function Classification System (GMFCS) levels; however, this study did not provide a comparison endurance measure for those in GMFCS levels IV and V to establish convergent validity. EASE scores were significantly lower for children in GMFCS levels IV and V; however, study results were unable to discriminate actual endurance deficits versus perceived endurance deficits due to limitations in self-initiated movement and mobility in these specific children. Therefore, therapists should interpret EASE outcomes cautiously for children in GMFCS levels IV and V. Continued psychometric evaluation of the EASE is warranted to establish responsiveness to measure endurance changes over time. The authors state that the EASE likely measures a different construct of endurance capacity from walking; however, further research is needed to determine how EASE results correlate with specific motor functions (other than walking) and participation in daily activities at home, school, and community settings. Helen Carey, PT, DHSc, PCS Kettering College Kettering, Ohio Jessica Lewis, PT, DPT, PCS Nationwide Children's Hospital Columbus, Ohio