PSYCHOMETRIC PROPERTIES OF FUNCTIONAL CAPACITY TESTS IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW

Scalco, Janaina Cristina; Martins, Renata; Keil, Patricia Morgana Rentz; Mayer, Anamaria Fleig; Schivinski, Camila Isabel Santos

doi:10.1590/1984-0462/;2018;36;4;00002

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 36 (04) • Oct-Dec 2018 • https://doi.org/10.1590/1984-0462/;2018;36;4;00002 copy

PSYCHOMETRIC PROPERTIES OF FUNCTIONAL CAPACITY TESTS IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To identify studies that evaluated psychometric properties of functional capacity tests in children and adolescents, and to verify which of these have satisfactory properties of measurement.

Data sources:

Searches on MEDical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SciELO) databases without limiting period or language. Two investigators independently selected articles based on the following inclusion criteria: children and/or adolescent population (healthy or with cardiorespiratory diseases); and assessment of psychometric properties of functional capacity tests. Studies with (I) adult samples, (II) sample with neurological diseases, and (III) on reference values or prediction equations only were excluded.

Data synthesis:

From the total of 677 articles identified, 11 were selected. These evaluated the psychometric properties of the following tests: 6-minute walk test (6MWT) (n=7); 6MWT and the 3-minute step test (3MST) (n=1); and Incremental Shuttle Walk Test (ISWT) (n=3). Reproducibility and reliability were good for 6MWT and ISWT, and moderate for 3MST. The ISWT showed high validity measures for both healthy children and children with chronic respiratory disease. The validity of 6MWT varied across studies, and should be analyzed according to the health conditions of test takers. The validity of 3MST is unclear, and further studies in pediatric population are required.

Conclusions:

Most studies investigated 6MWT measurement properties. Validity of 6MWT varied according to different pediatric populations. The use of 6MWT, ISWT and 3MST tests to measure clinically important changes in children and adolescents with cardiorespiratory diseases is still unclear.

Keywords:
Child; Exercise tolerance; Validity of tests; Reproducibility of results

CINAHL with Full Text (EBSCO)
1. “Pediatr*”	9. “Exercise capacity”
2. “Child*”	10. “Activity of daily living”
3. “Adolescent”	11. (MH “Functional status”)
4. “School age”	12. “Physical capacity”
5. (MH “Child, Preschool”)	13. “Functional capacity”
6. (MH “Child”) AND (1 OR 2 OR 3 OR 4 OR 5)	14. “Everyday activities”
7. (MH “Exercise test”)	15. (“Every day activities”) AND (7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14)
8. “Exercise tolerance”	16. 15 AND 6
MEDLINE via OVID
1. Randomized controlled trials as Topic/	25. School age.mp.
2. Randomized controlled trial/	26. Child, Preschool/
3. Random allocation/	27. 22 or 23 or 24 or 25 or 26
4. Double blind method/	28. Step test.mp.
5. Single blind method/	29. Shuttle walk test.mp.
6. Clinical trial/	30. Six-minute walk test.mp.
7. exp Clinical Trials as Topic/	31. Cardiopulmonary test.mp.
8. (clinic$ adj trial$1).tw.	32. Ergoespirometry.mp.
9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8	33. Free running test.mp.
10. (Follow up adj (study or studies).tw.	34. Exercise Test/
11. (observational adj (study or studies).tw.	35. Exercise capacity.mp.
12. Longitudinal.tw.	36. Functional capacity.mp.
13. Retrospective.tw.	37. Functional status.mp.
14. review.pt.	38. Physical capacity.mp.
15. 10 or 11 or 12 or 13 or 14	39. 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38
16. 9 or 15	40. lResponsiveness.mp.
17. Case report.tw.	41. Minimal clinically important difference.mp.
18. Letter/	42. Equation reference.mp.
19. Historical article/	43. Reference Values/
20. 17 or 18 or 19	44. Reliability.mp.
21. 16 not 20	45. Validity.mp.
22. Child*.mp.	46. Reproducibility.mp.
23. Pediatr*.mp.	47. 40 or 41 or 42 or 43 or 44 or 45 or 46
24. Adolescent*.mp.	48. 21 and 27 and 39 and 47

Author/ year	Checklist STROBE	Population and sample	Method	Psychometric property assessed
Gulmans et al., 1996	15.1	Children and adolescents with CF aged 8 to 18 years (mean 11.1±2.2 years) (n=15 validity) (mean 14.5±2.0 years) (n=23 reproducibility)	V: 1 6MWT and a test in cycle (10W increment if height was <160 cm, or FEV1 <60%, or 15 W per minute) performed for at least two days before or two days after 6MWT. R: 2 6MWT (8-m lane, encouraging every 16 m) in the same day and repeated after a week.	Validity Reproducibility	Correlation between CD and VO_2máx (r=0.76). r=0.90.
Li et al., 2005	16.1	Healthy Chinese children aged 12 to 16 years (mean 14.2±1.2 years) (n=74 validity) (n=52 reliability)	V concurrent: maximum CPET on treadmill and 6MWT with interval of up to 2 weeks between them. Re: 6MWT was repeated at intervals of 2 to 4 weeks.	Validity Reliability	Correlation between DC. 6MWT and VO_2max (r=0.44). ICC=0.94.
Lammers et al., 2011	14.1	Children with pulmonary hypertension aged 6 to 18 years (mean 13.0±3.0 years)	V: All of them performed maximum CPET on cycle ergometer and the 6MWT.	Validity	Correlation between DC. 6MWT and VO_2peak with VO_2VT (r=0.49 e r=0.40. respectively)
Cunha et al., 2006	12.1	Children with CF aged 8 to 14 years (mean 11.0±1.9 years) (n=16)	Two 6MWT (28-m lane) were performed on the same day, with a minimum interval of 30 min between them.	Reproducibility	No difference between DCs (p=0.31). which shows good reproducibility
Priesnitz et al., 2009	15.1	Healthy children and adolescents aged 6 to 12 years (mean 11.7 years)	R: Two 6MWT (30-m lane), with interval of 30 min	Reliability	ICC: 0.74.
Morinder et al., 2009	14.1	Obese children and adolescents aged 8 to 16 years (mean 13.2 years) (n=49 reproducibility) (n=250 validity)	V: 6MWT and a submaximal exercise test on a stationary bicycle for same-day comparison. R: Two 6MWT (70-m lane), with mean interval of 4 days	Validity Reproducibility	Correlation between DC in 6MWT with VO_2max (r=0.34). ICC=0.84.
Mandrusiak et al., 2009*	13.9	Children and adolescents with CF aged 7 to 17 years (mean 13.1±2.7 years) hospitalized for respiratory exacerbation (n=18)	Re: After one or two days of hospital admission, a 6MWT was performed per day on two consecutive days.	Reliability	ICC=0.93

Author/ year	Checklist STROBE	Population and sample	Method	Psychometric property assessed
Balfour-Lynn et al., 1998	13.1	Children with symptomatic CF 6-18 years (mean 12.5 years) (n=54, validity) (n=12 reproducibility - 3MST) (n=9 reproducibility - 6MWT)	V: two 3MST performed and compared to two 6MWT (17-m lane), with interval of 30 min between them on the same day. Re: 3MST and 6MWT performed on two consecutive days. For all analyzes, we used the change of the SpO₂ parameters, HR, degree of dyspnea.	Validity	3MST produced significantly higher HRs and Borg compared to the 6MWT. The decrease in SpO₂ was similar between tests. Relation between SpO₂ decrease and baseline FEV1 also similar in both tests (3MST r = 40.52 and 6MWT r = 40.51)
Balfour-Lynn et al., 1998	13.1			Reproducibility	3MST: (SpO₂: -2.1 to 2.5; HR: -38.0 a 34.0; Borg: -1.5 a 1.5) 6MWT: (SpO₂: -1.7 to 1.0; HR:-34.0 a 39.0; Borg: -1.1 a 1.9).
Selvadurai et al., 2003*	15.3	CF children aged 5-17 years (mean 6.8 years) n=35 (children aged 7 years or less, or too weak to perform a 20-m shuttle test run).	All children performed a CPET on a treadmill, two ISWT tests with simultaneous gas analysis and one ISWT test without oxygen mask in a maximum interval of one week.	Reproducibility	No significant difference between the two ISWT tests with the mask on or in comparison with and without mask for heart rate peak, DC, SpO₂, Borg and VO_2peak
Selvadurai et al., 2003*	15.3			Validity	Strong correlation between DC and VO_2peak (r = 0.91); there were no significant differences in variables between ISWT and CPET.
Coelho et al., 2007*	12.1	Children and adolescents with CF: CFG (n=14) and healthy: CG (n = 14) 7-15 years CFG (11.57 ± 2.50) CG (11.28 ± 1.85)	Each child performed at least two tests with a minimum 30-minute interval between them.	Reproducibility	CG: DC greater in the second test (p = 0.036). CFG: significant difference between first and second test only as to resting dyspnea scale, which increased in the second test, just like in healthy children (p = 0.042).
Lanza et al., 2015	16.0	Brazilian Children and adolescents with normal pulmonary function and no chronic diseases (n=8) 6-18 years (mean age 12±2 years)	Two ISWT tests performed with interval of 30 min between them.	Reliability	ICC = 0.98 excellent reliability of distance covered between ISWT 1 and 2.

Test	Validity	Reproducibility/Reliability	Feasibility	MCID	Other populations
6MWT
ISWT
3MST

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[1] *Corresponding author. E-mail: cacaiss@yahoo.com.br (C.I.S. Schivinski).