Title: New Path, Better Understanding: Promoting performance accuracy and defensible estimation of exercise capacity in young children
Name: Adane Durham
Primary Presenters: Adane Durham
College of Health Sciences
Undergraduate
Faculty Sponsor(s): Victoria Moerchen
Background:
The 2-Minute Walk Test (2MWT) measures functional exercise capacity. Although the NIH protocol for the 2MWT is for ages 3-85 years, most studies that use this tool with young children report needing to significantly modify the standard protocol. This reduces the reliability of outcomes across studies. We propose that if a child does not understand the instructions, their performance will be compromised and their exercise capacity underestimated. This study compared the performance errors of young children on the NIH 2MWT protocol vs a child-friendly 2MWT protocol.
Methods:
Fifteen, 3-6 year-old typically developing children performed two versions of the 2MWT in random order: Path 1, the standard NIH protocol, and Path 2, Modified Accessibility Path (MAP protocol) designed to support the cognitive and attentional needs of young children. The NIH protocol used the published instructions; the MAP protocol used simpler language, systematic performance reminders, and a visually supportive walking path. Performance was video recorded and later coded for motor errors. The coding scheme reflected salient components of the 2MWT instructions: walking for 2 minutes, fast walking/not running, continuous walking, correct walking direction along path, and correct walking direction through the turns. Inter-rater reliability was 98%. Errors were summed across completed laps and an accuracy score was computed per protocol for each child. Repeated measures Poisson regression controlled for differences in total possible errors within and between children per protocol. A non-parametric Wilcoxon signed-rank test was used to compare performance by protocol.
Results:
Children’s accuracy on the MAP protocol was significantly better than with the NIH protocol (p < 0.0001). Children had fewer errors per lap with the MAP protocol (p = 0.03), despite walking a significantly greater distance (p = 0.006).
Conclusions:
The MAP protocol supported accuracy of performance and reduced underestimation of the exercise capacity of young children.
Adane, we are looking forward to having you start the DPT program in less than a month. Great job on your presentation of this important work. It appears that the modified protocol was very effective in minimizing errors compared to the ‘adult’ version. It would be interesting to estimate the cost of errors on total distance to determine the amount of underestimation with the NIH toolbox version of the test.
Again, great job!
Great job, Adane! I am so excited to have you joining the DPT program shortly.