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Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis
Hiroaki Nakashima1,2, Noriaki Kawakami1,3, Hiroko Matsumoto4
1Meijo Hospital Orthopedics and Spine Center, Naka-ku, Nagoya.
Insights
The 6-minute walk test (6MWT) is reduced in children with congenital scoliosis and rib anomalies, correlating with curve severity but not lung function. This test is a feasible measure for assessing functional capacity in these patients.
Area of Science:
- Pediatric Orthopedics
- Pulmonology
- Rehabilitation Medicine
Background:
- The 6-minute walk test (6MWT) assesses cardiopulmonary and neuromuscular function in pediatric populations.
- Congenital scoliosis with rib anomalies presents unique challenges to functional assessment.
Purpose of the Study:
- To investigate the relationship between 6-minute walk test (6MWT) distance, forced vital capacity (FVC), and the major curve in children with congenital scoliosis and rib anomalies.
- To evaluate the 6MWT as a functional measure in this specific pediatric cohort.
Main Methods:
- A retrospective cohort study involving 20 children with congenital scoliosis and rib anomalies before surgical treatment.
- Collected data included 6MWT distance, forced vital capacity percentage (FVC%), and Cobb angle of the major curvature.
- Linear regression analysis was employed to determine correlations between these parameters.
Main Results:
- Children exhibited significantly reduced 6MWT distances (386.3±59.4 m), performing below predicted norms.
- 6MWT distance showed a significant negative correlation with the Cobb angle (ρ=-0.61, P=0.004).
- No significant correlation was found between 6MWT distance and FVC% (ρ=0.17, P=0.49).
Conclusions:
- The 6MWT is a feasible and valuable tool for assessing functional capacity in children with thoracic congenital scoliosis and rib anomalies.
- Preoperative 6MWT distance is significantly influenced by the severity of the spinal curvature.
- Lung function, as measured by FVC%, does not appear to be a primary determinant of 6MWT distance in this population.
Background:
The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies.
Methods:
The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis.
Results:
The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49).
Conclusions:
The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment.
Level Of Evidence:
Level IV-retrospective cohort study.
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