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One-Minute Walk and modified Timed Up and Go tests in children with cerebral palsy: performance and minimum
Insights
This study evaluated the modified Timed Up and Go (mTUG) and One-Minute Walk Test (1MWT) in children with bilateral cerebral palsy (CP). Performance varied by Gross Motor Function Classification System (GMFCS) level, with established minimum clinically important differences (MCIDs) aiding intervention assessment.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Movement Science
Background:
- Bilateral cerebral palsy (CP) significantly impacts motor function.
- Standardized assessments are crucial for tracking functional changes in children with CP.
- The modified Timed Up and Go (mTUG) and One-Minute Walk Test (1MWT) are commonly used mobility measures.
Purpose of the Study:
- To assess the performance and changes over 12 months in mTUG and 1MWT in children with bilateral CP.
- To establish Minimum Clinically Important Differences (MCIDs) for these tests.
- To compare outcomes with and without surgical intervention across different Gross Motor Function Classification System (GMFCS) levels.
Main Methods:
- Prospective, multicenter study of 219 participants with bilateral spastic CP (GMFCS I-III).
- Evaluations conducted at baseline and 12-month follow-up.
- Participants divided into non-surgical (n=168) and surgical (n=51) groups; MCIDs derived from non-surgical group's change scores.
Main Results:
- Dependent walkers (GMFCS III) took longer on mTUG (p≤0.01) than independent walkers (GMFCS I-II).
- 1MWT distance decreased with increasing impairment (p≤0.01).
- No significant differences in mTUG and 1MWT change scores between surgical and non-surgical groups at any GMFCS level.
Conclusions:
- Children with bilateral CP demonstrate varying performance on mTUG and 1MWT based on GMFCS level.
- Established MCID values provide a benchmark for interpreting changes and evaluating interventions.
- These findings support the use of mTUG and 1MWT for monitoring functional status in pediatric CP.
Abstract:
AIM This prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One-Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools. METHOD Two hundred and nineteen participants with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] levels I–III) were evaluated at baseline and 12 months follow-up. The non-surgical group (n=168; 54 females, 114 males; mean age 12y 11mo, [SD 2y 7mo], range 8y 1mo–19y) had no surgical interventions during the study. The surgical group (n=51; 19 females, 32 males; mean age 12y 10mo [SD 2y 8mo] range 8y 2mo–17y 5mo) underwent soft-tissue and/or bony procedures within 12 months from baseline. The mTUG and 1MWT were collected and MCIDs were established from the change scores of the non-surgical group. RESULTS Dependent walkers (GMFCS level III) required more time to complete the mTUG (p≤0.01) than independent walkers (GMFCS levels I and II). For the 1MWT, distance walked decreased with increasing impairment (p≤0.01). 1MWT and mTUG change scores were not significantly different at any GMFCS level for either the surgical or non-surgical groups (p≤0.01). INTERPRETATION Children with varying levels of function (GMFCS level) perform differently on the 1MWT and mTUG. The data and MCID values can assist clinicians in interpreting changes over time and in assessing interventions.