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Six-minute walk test and pulmonary function in ambulatory children with early-onset scoliosis
Karina A Zapata1, Charles E Johnston2, Tiffany H Thompson2
1Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA. Karina.zapata@tsrh.org.
Insights
Children with early-onset scoliosis (EOS) show significantly reduced aerobic function on the six-minute walk test (6MWT) compared to controls. This objective measure correlates with pulmonary function, highlighting a need for further research.
Area of Science:
- Pediatric Orthopedics
- Pulmonology
- Rehabilitation Medicine
Background:
- The six-minute walk test (6MWT) is a key measure of aerobic capacity.
- Normative data for the 6MWT in early-onset scoliosis (EOS) populations is lacking.
- Understanding functional ambulation in EOS is crucial for assessing treatment efficacy.
Purpose of the Study:
- To establish normative 6MWT distances and standard deviations (SD) for children with EOS compared to age- and sex-matched controls.
- To investigate correlations between 6MWT performance and pulmonary function tests (PFTs) in EOS patients.
- To evaluate differences in 6MWT distances between EOS subtypes (congenital, idiopathic, neuromuscular, syndromic).
Main Methods:
- Retrospective review of 163 ambulatory children with EOS who underwent 6MWT and PFTs (Forced Vital Capacity [FVC]% and Forced Expiratory Volume in one second [FEV1]%) between 2012 and 2023.
- Comparison of 6MWT distances and SDs against age- and sex-matched healthy controls.
- Analysis of correlations between 6MWT distance and PFT parameters (FVC%, FEV1%).
Main Results:
- Children with EOS walked significantly shorter distances on the 6MWT compared to controls, with only 12% falling within 1 SD of the mean.
- Congenital/Idiopathic (C/I) EOS subgroups walked farther than Neuromuscular/Syndromic (N/S) subgroups but still demonstrated clinically significant deficits compared to controls.
- 6MWT distance showed significant positive correlations with FEV1% (r=0.29, p=0.001) and FVC% (r=0.27, p=0.003).
Conclusions:
- The 6MWT provides an objective assessment of functional ambulation in EOS patients and correlates with pulmonary function.
- Despite better performance than N/S subtypes, C/I EOS patients exhibit substantial aerobic functional compromise.
- The current lack of objective functional data hinders the evaluation of treatment effectiveness in EOS, underscoring the need for multi-center prospective studies.
Purpose:
The six-minute walk test (6MWT) measures aerobic function, but normative values for early-onset scoliosis (EOS) do not exist. This study assesses 1) 6MWT distances for children with EOS and standard deviations [SD] from age- and sex-matched normal controls, and 2) correlations between 6MWT and pulmonary function tests (PFTs).
Methods:
We performed a retrospective review of 6MWTs administered at a single institution from 2012 to 2023. PFTs were obtained: Forced vital capacity (FVC) percent (%) and forced expiratory volume in one second (FEV1) %.
Results:
163 ambulatory children with EOS whose average age was 10.7 ± 3.7 years (range: 3.6-18 yrs) performed a 6MWT. There were 80 congenital (C), 37 idiopathic (I), 17 neuromuscular (N) and 28 syndromic (S) children with curves averaging 69° ± 28°. Only 12% (20/163) walked within 1 SD of the mean. C/I walked farther than N/S (440 m vs. 373 m, p = 0.004) and demonstrated 6MWT SD's closer to controls (-3.0 vs. -3.9, p = 0.009). However, they still walked 150 m to 288 m less than controls depending on age and sex (well above the clinically important difference). 6MWT distance correlated with FEV1% (r = 0.29, p = 0.001) and FVC% (r = 0.27, p = 0.003).
Conclusions:
The 6MWT is an objective measure of functional community ambulation that correlates with PFTs in EOS patients. C/I performs closer to controls than N/S but demonstrate clinically significant aerobic functional compromise when compared to age- and sex-matched controls. The lack of objective functional data limits our understanding of treatment efficacy for EOS. Multi-center prospective research is warranted.
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