Functional Walking Test (FWT): Difference between revisions

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== Introduction ==
== Introduction ==
[[File:Child tiptoes.jpg|right|frameless|250x250px]]
[[File:Child tiptoes.jpg|right|frameless|250x250px]]
The Functional Walking Test (FWT) also known as The 6-minute walk test (6MWT) is a submaximal exercise test designed to assess clinical populations' functional exercise capacity. It measures the distance walked in six minutes.  
The Functional Walking Test (FWT) is a simple tool used to measure functional mobility in children with [[Cerebral Palsy Introduction|Cerebral Palsy (CP)]]. The Functional Walking Test was developed to assess balance associated with walking, and to analyze and measure the functional walking ability in children. <ref name=":0">Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.</ref>


Because of characteristics such as growth stage and age, obtaining reference values in the paediatric population is especially difficult so it would be useful to assess children with neurological or musculoskeletal conditions that affect their ability to walk.<ref name=":1">Mylius, C. F., Paap, D., & Takken, T. (2016). Reference value for the 6-minute walk test in children and adolescents: a systematic review. ''Expert Review of Respiratory Medicine'', ''10''(12), 1335–1352. <nowiki>https://doi.org/10.1080/17476348.2016.1258305</nowiki></ref>
It was developed since scales such as the [[Gross Motor Function Measure|Gross Motor Function Measure (GMFM)]], the Functional Mobility Scale (FMS), and the [[Berg Balance Scale|Berg Balance Scale (BBS)]], all lack qualities that were directed towards higher functioning children with cerebral palsy, higher level of gross motor ability, or limitations for children with [[hemiplegia]]. <ref name=":0" />


The FWT consists of several components, including:
A 'functional walk' can be classified as the ability to stop, start, turn, and get into a position. <ref name=":0" />


* Walking 10 meters
== Audience ==
* Ascending and descending a step
It is expected that all the items on the test can be performed by a 4-year old without motor impairments. <ref name=":0" />
* Walking on tiptoes and heels.
 
The child is timed during each task, and the results are used to assess their functional mobility.A '''<nowiki/>'functional walk'''' can be classified as the ability to stop, start, turn, and get into a position. <ref name=":0">Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.</ref>
 
The FWT is a reliable and valid assessment tool that has been used in several studies to evaluate children with various conditions, including [[Cerebral Palsy Introduction|cerebral palsy]], [[Muscular Dystrophy|muscular dystrophy]], and [[Spina Bifida|spina bifida]]. It can be used to assess changes in a child's mobility over time and to evaluate the effectiveness of interventions.<ref name=":1" />


== Development of the Functional Walking Test ==
== Development of the Functional Walking Test ==
The Functional Walking Test (FWT) was developed by K. Barry and J. Hussey in 2004 as a modification of the 6-Minute Walk Test (6MWT), which was originally developed for adults. The FWT was specifically designed for use in children with neurological or musculoskeletal conditions that affect their ability to walk.<ref name=":2">Barry K, Hussey J. Development of the Functional Walking Test for children with cerebral palsy. J Pediatr Orthop. 2004;24(2):215-8. doi: 10.1097/01241398-200403000-00020. PMID: 15076585.</ref>
The scale was initially developed in several stages. It was primarily developed as an ordinal scale, from a focus group of clinicians and therapists who identified characteristics and items of functional walking. Subsequent to this, items were removed and reliability testing was conducted. <ref name=":0" />
[[File:Child stairs.jpg|right|frameless|240x240px]]
The Functional Walking Test consists of 11 tests, divided into 5 categories: <ref name=":0" />


== Method of use ==
* Kneeling
'''Equipment Required:'''
* Standing from kneeling
* Standing
* [[Gait Analysis in Cerebral Palsy|Walking]]
* Stairs


* Stopwatch or timer
* Tape measure
* Step: A step that is approximately 15 cm (6 inches) high is needed for the second task of ascending and descending a step.
* Assisted devices: Assisted devices such as walkers, crutches or canes may be required for some children during the test.


'''Set-Up:'''
Specific rules and guidelines of the test are explained in a manual that comes with the test. <ref name=":0" />


* Open space that is at least 10 meters (33 feet) long.
The maximum score is 23. <ref name=":0" />
* Flat surface and no obstacles.


'''Patient Instructions:'''
Of these five categories, items examined include the ability to walk on one's knees, to ascend and descend an incline, and to walk on a narrow beam. These actions test for aspects of [[balance]] and [[Postural Control|postural control]] necessary for [[gait]]. <ref name=":0" />


* During the FWT, the child is instructed to walk 10 meters (33 feet) as quickly and safely as possible, with or without an assistive device if needed. The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's foot crosses the finish line.
The test is quick and easy to conduct, taking less than 10 minutes to score. It is done on a special scoring template, and takes minimal equipment and space to conduct. <ref name=":0" />
* After completing the 10-meter walk, the child is asked to ascend and descend a step that is approximately 15 cm (6 inches) high. The child's time is measured using a stopwatch, starting when the child's foot touches the first step and stopping when the child's foot touches the ground on the other side.
* Next, the child is asked to walk on their tiptoes for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's heel touches the ground.
* Finally, the child is asked to walk on their heels for 10 meters (33 feet). The child's time is measured using a stopwatch, starting when the child's foot crosses the starting line and stopping when the child's toes touch the ground.<ref name=":2" />


[[File:10MWTpathrepresentation.jpg|center|frameless|845x845px]]
== Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF) ==
The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability, and Health (ICF)]]. It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. <ref name=":0" />


== Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF) ==
It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. <ref name=":0" /> 


* The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the [[International Classification of Functioning, Disability and Health (ICF)|International Classification of Functioning, Disability, and Health (ICF)]]. It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. <ref name=":0" />
When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. <ref name=":0" />     
* It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. <ref name=":0" />
* When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. <ref name=":0" />     


== Reliability and Validity ==
== Reliability and Validity ==
The FWT has been shown to be a reliable and valid assessment tool for measuring functional mobility in children with various neurological or musculoskeletal conditions. One study evaluated the reliability of the FWT in children with cerebral palsy and found high intra-rater and inter-rater reliability, with intraclass correlation coefficients (ICCs) ranging from 0.96 to 0.98. <ref name=":3">Ko J, Kim M, Hwang J, Kim Y, Kim Y, Lee S. Validity and reliability of the functional walking test for children with cerebral palsy. Disabil Rehabil. 2020;42(1):123-128. doi: 10.1080/09638288.2018.1533264. Epub 2018 Nov 6. PMID: 30398044.</ref>
To assess the reliability and validity of the Functional Walking Test, it was compared to sections D and E of the GMFM. The GMFM is a clinical measure that was intended to test for changes in gross motor function in children with cerebral palsy. The GMFM is a scale used as a benchmark, which has gone through various tests of reliability and validity. When a test and retest, of the FWT and the GMFM, at a future date, were compared. The tests using the FWT had a high correlation in relation to the GMFM, which indicated that the FWT had a high reliability and validity. Correlation values were 0.86 and 0.87 at two different times, with a correlation coefficient greater than 0.76 indicating a strong association. It was seen that subjects achieved less than the top score when completing the FWT, whereas they would easily achieve the top score when completing the GMFM. This indicates that the FWT may be presenting more challenging tasks than the GMFM. <ref name=":0" />
 
Another study found that the FWT had good concurrent validity when compared to the 6-minute walk test in children with spina bifida.<ref name=":3" />
 
In addition, the FWT has been shown to be sensitive to changes in walking ability over time, and can be used to monitor the effects of different interventions on functional mobility in children with cerebral palsy. One study found that changes in FWT scores correlated with changes in walking speed and gross motor function in children with cerebral palsy.
 
Overall, the FWT is a reliable and valid tool for assessing functional mobility in children with neurological or musculoskeletal conditions.
 
 
== References  ==
== References  ==



Latest revision as of 10:58, 6 July 2023

Original Editor - Kapil Narale

Top Contributors - Kapil Narale, Aya Alhindi and Kim Jackson  

Introduction[edit | edit source]

Child tiptoes.jpg

The Functional Walking Test (FWT) is a simple tool used to measure functional mobility in children with Cerebral Palsy (CP). The Functional Walking Test was developed to assess balance associated with walking, and to analyze and measure the functional walking ability in children. [1]

It was developed since scales such as the Gross Motor Function Measure (GMFM), the Functional Mobility Scale (FMS), and the Berg Balance Scale (BBS), all lack qualities that were directed towards higher functioning children with cerebral palsy, higher level of gross motor ability, or limitations for children with hemiplegia. [1]

A 'functional walk' can be classified as the ability to stop, start, turn, and get into a position. [1]

Audience[edit | edit source]

It is expected that all the items on the test can be performed by a 4-year old without motor impairments. [1]

Development of the Functional Walking Test[edit | edit source]

The scale was initially developed in several stages. It was primarily developed as an ordinal scale, from a focus group of clinicians and therapists who identified characteristics and items of functional walking. Subsequent to this, items were removed and reliability testing was conducted. [1]

Child stairs.jpg

The Functional Walking Test consists of 11 tests, divided into 5 categories: [1]

  • Kneeling
  • Standing from kneeling
  • Standing
  • Walking
  • Stairs


Specific rules and guidelines of the test are explained in a manual that comes with the test. [1]

The maximum score is 23. [1]

Of these five categories, items examined include the ability to walk on one's knees, to ascend and descend an incline, and to walk on a narrow beam. These actions test for aspects of balance and postural control necessary for gait. [1]

The test is quick and easy to conduct, taking less than 10 minutes to score. It is done on a special scoring template, and takes minimal equipment and space to conduct. [1]

Functional Walking Test (FWT) and the International Classification of Functioning, Disability, and Health (ICF)[edit | edit source]

The FWT was designed to be a quick and simple assessment of functional walking ability. This is classified to fit within the 'activity' category of the International Classification of Functioning, Disability, and Health (ICF). It's specific purpose is to assess physical function and balance associated with gait, without targeting any other areas of gross motor function. [1]

It does not address any other aspects of the ICF, such as, Bodily Structure and Function, or Participation. [1]

When a more holistic profile of a child is needed, the FWT can be administered with other measure or tests, which address the other respective aspects of the ICF. [1]

Reliability and Validity[edit | edit source]

To assess the reliability and validity of the Functional Walking Test, it was compared to sections D and E of the GMFM. The GMFM is a clinical measure that was intended to test for changes in gross motor function in children with cerebral palsy. The GMFM is a scale used as a benchmark, which has gone through various tests of reliability and validity. When a test and retest, of the FWT and the GMFM, at a future date, were compared. The tests using the FWT had a high correlation in relation to the GMFM, which indicated that the FWT had a high reliability and validity. Correlation values were 0.86 and 0.87 at two different times, with a correlation coefficient greater than 0.76 indicating a strong association. It was seen that subjects achieved less than the top score when completing the FWT, whereas they would easily achieve the top score when completing the GMFM. This indicates that the FWT may be presenting more challenging tasks than the GMFM. [1]

References[edit | edit source]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Quinn Aoife, O'Regan Myra, Horgan Frances. Psychometric evaluation of the functional walking test for children with cerebral palsy. Disability and Rehabilitation. 2011:33(25–26): 2397–2403.