Test–retest reliability of the 10‐metre fast walk test and 6‐minute walk test in ambulatory school‐aged children with cerebral palsy

Abstract

Short-term test-retest reliability of the 10-metre fast walk test (10mFWT) and 6-minute walk test (6MWT) was evaluated in 31 ambulatory children with cerebral palsy (CP), with subgroup analyses in Gross Motor Function Classification System (GMFCS) Levels I (n=9), II (n=8), and III (n=14). Sixteen females and 15 males participated, mean age 9 years 5 months (SD 3y 7mo, range 4y 3mo-18y 2mo). Twenty had spastic diplegia, while the others had another form of CP. Retest interval varied from 1 to 4 weeks (mean 10.6d [SD 6.4]). Intraclass correlation coefficients (ICCs) estimated reliability. The 10mFWT ICC was 0.81 (95% confidence interval [CI] 0.65-0.90) across participants, and >0.59 in GMFCS subgroups (95% CI lower bound >0.01). The 6MWT ICC was 0.98, and >0.90 in GMFCS subgroups (95% CI lower bound >0.64). Bland-Altman plots indicated bias towards higher 6MWT retest distances in GMFCS Level I. Minimum detectable change (95% CI) was 61.9, 64.0, and 47.4m for the 6MWT within GMFCS Levels I, II, and III respectively. The conclusion is that while the 10mFWT showed inadequate test-retest reliability given its wide 95% CI, the 6MWT demonstrated good to excellent reliability. Investigation of the need for a practice walk when administering the 6MWT with children in GMFCS Level I is recommended to establish their fastest pace.

Test–retest reliability of a 1-min walk test in children with bilateral spastic cerebral palsy (BSCP)

“…Previous papers on the latter [7][8][9] have documented ICC scores of 0.99, 0.98 and 0.98 Table 1 Means AE S.D. (range) for subject characteristics and study data.…”

“…The work of Andersson et al [7], which compared four walks conducted over four different days (carried out in adults with CP), demonstrated positive bias without the inclusion of a 'practice' walk; repeatability coefficients dropped from 66 m to 40 m once data from the first test day were excluded from the analysis. Alternatively, Thompson et al [8] compared two walks conducted on two different days without the use of a practice walk (carried out in children with CP). Despite a systematic bias of 7.3 m (walking distance greater on the second test day) and a repeatability of 54.9 m, they concluded that a practice walk was not necessary in the majority of children with CP.…”

“…Despite the growing use of WTs as a useful outcome tool within areas of rehabilitation medicine [3][4][5][6], research regards their validity and reliability in children and adults with disability is just starting to appear within the literature. Three recent papers concluded high test-retest reliability of the 6-min protocol in adults [7] and children [8,9] with cerebral palsy (CP), although results conflicted with regards to the necessity of a practice walk. Considerably less work has been conducted on WTs of lesser duration.…”

Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians

“…The outcome measures were listed within each 40 Walking + + ) 5-MWT a, 41,42 Walking + + ) 6-MWT 17,18 Walking + + ) 8-MWT 43 Walking + + ) 600yd walk ⁄ run test 44 Walking + + ) 30-s walk test 44 Walking + + ) Half-mile walk ⁄ run test 45 Walking + ) ) Arm-cranking ergometer protocol 24 Arm cranking + + ) 5-min treadmill economy test 46 Walking + ) ) EEI-HR overground walk test 13 Walking + ) ) 6-min wheelchair riding test a Riding ) + + Maximal Bruce protocol 47 Walking + ) ) 10m SRT (SRT-I and SRT-II) 19 Walking + ) ) Treadmill test 19 Walking + ) ) Treadmill test 48 Walking + ) ) Treadmill test 38 Walking + ) ) McMaster all-out protocol cycle test 4 Cycling ⁄ arm cranking + + + Ergometer test (cycle or cranking) 49 Cycling of the GMFCS levels (levels I and II were combined because the responses were the same for the two levels). The submaximal exercise test for which reliability and concurrent validity data were found in CP was the 1-minute walk test (MWT; intraclass correlation [ICC]=0.94 for GMFCS levels I, II, III, and IV; significant correlation between Gross Motor Function Measure score and the distance covered during the 1min walk).…”

“…15,16 Reliability was found for the 6-MWT (ICC=0.93, 0.91, and 0.99 for GMFCS levels I, II, and III respectively). 17,18 For maximal exercise tests, the 10-meter shuttle run tests (SRT-I; for children classified at GMFCS level I [starting speed 5km per h] and SRT-II for children classified at GMFCS level II [starting speed 2km per h]; ICC>0.97) 19 and the McMaster all-out cycle test (r s >0.72-0.92) 4 were the only two tests with published (test-retest) reliability data in CP. One participant provided additional unpublished psychometric data regarding a maximal exercise test (7.5m shuttle walk ⁄ run test) for children classified at GMFCS level III.…”