CLINICAL BOTTOM LINE

Commentary on Development of the Early Activity Scale for Endurance for Children With Cerebral Palsy

How should I apply this information?

The authors developed an 11-item parent-report questionnaire, the Early Activity Scale for Endurance (EASE), to
measure physical activity endurance in young children with cerebral palsy (CP) aged 1.5 to 5 years. Data from 414
children with CP and 106 children without CP were used to establish construct validity. A subsample of 14 children
with CP participated in the convergent validity testing using EASE total scores and distance covered in the 6-Minute
Walk Test. A subsample of 32 children with CP participated in test-retest reliability.
The authors report that the EASE is a feasible tool to estimate physical activity endurance in young children with CP
at all GMFCS levels. The tool was developed in natural environments, but the authors indicate that it can be used as
an indirect measure of endurance in clinical and research settings. The authors suggest that using the EASE in natural
environments may more accurately reflect a childs endurance and may be useful in identifying the need for fitness
interventions.
What should I be mindful about in applying this information?
The EASE is a parent-report measure to describe physical activity patterns and behaviors in children with CP aged
1.5 to 5 years. The authors included frequency, intensity, and duration in their operational definition of endurance. It
appears that the EASE measures a combination of these dimensions, making it somewhat difficult to draw a conclusion
about the individual dimensions affecting a childs physical activity level. Further cognitive testing with respondents
is needed to assist with determining item content for the EASE. Authors indicate that Minimal Detectable Difference
(8 points) is high, suggesting that a change of up to 8 points may be due to measurement error.
The authors discuss the inherent bias in self-report measures and suggest that the EASE requires further testing
against objective measures of physical activity intensity, duration, endurance, and frequency to determine criterion
validity. It may be important to establish criterion validity before the EASE is used as an intervention outcome measure.
In its current format, the EASE provides a systematic way to describe physical activity patterns and behaviors in young
children with CP.

Margaret E. ONeil, PT, PhD, MPH

Drexel University, Philadelphia, Pennsylvania
Maria Fragala-Pinkham, PT, DPT
Franciscan Hospital for Children, Brighton, Massachusetts
The authors declare no conflicts of interest.
DOI: 10.1097/PEP.0b013e31825cc9c2

Pediatric Physical Therapy EASE for Children With Cerebral Palsy 241
Copyright 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.