Egen Klassifikation (EK, EK Scale)
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General Information
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| Objectives |
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This is a disease specific measure of functional ability for non ambulatory individuals with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy (SMA). It was developed for clinical use to plan intervention and to evaluate the effect of intervention in the non-ambulatory stages of DMD or SMA.
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| Category of Outcome Measure |
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| Disease Type |
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Used |
Validated |
| Anterior Horn Cell Disease |
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X |
| Muscle |
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X |
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| Chronology of Development |
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The EK scale was developed in 1982 in Denmark in the ''Treatment and Guidance Centre' of the Danish muscular dystrophy association as a tool to assess functional ability among non-ambulatory people with DMD. There was a need to be able to assess and evaluate the overall physical ability in these stages of the diseases, not as a solely arm-function measure, but reflecting most of the physical/functional changes. It was clear that small changes of function in one domain influenced functional ability in other domains. Therefore a hollistic approach was necessary. An occupational therapist, Jette Mřller and a physiotherapist, Birgit Steffensen, both with a long clinical experience in DMD and SMA described the categories and items of the scale. The scale was translated into English and in it's original version presented and discussed at workshops for European physiotherapist specialised in neuromuscular disesases and under the auspices of the European Alliance of Muscular Dystrophy Associations (EAMDA) in the early 1980s. The EK scale was later used in descriptive Danish studies. The validation process started after 1995 when it by chance was discovered that it had a predictive power with respect to the need of respiratory support among people with DMD (Chest: 1995). In the years 1997 - 2002 the EK scale was assessed with respect to it's reliability (Advances in Physiotherapy: 2002), content and discriminatory validitiy (Physiotherapy Research International: 2001), sensitivity to changes (Developmental Medicine and Child Neurology: 2002).
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| Mode of Assessment |
Administered by trained evaluator
Administered by untrained evaluator
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| Age Group |
Children (2 to 11 Years)
Adolescents (12 to 15 Years)
Adults (16 Years and Over)
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| Age Related Limitations |
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Children need to be accompanied by their parents or helpers to be sure that the information given is correct.
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| Languages |
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Original |
Definitive Validated Translation |
Informal Translation |
| Danish |
X |
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| English UK |
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X |
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| Portuguese |
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X |
| Spanish |
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X |
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| Swedish |
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X |
| Norwegian |
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X |
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| Conditions of Use and Contact Information |
| Organisation Name |
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Rehabiliterings Center for Muskelsvind
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| Postal Address |
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Kongsvang Allé 23, Ĺrhus C, 8000, Denmark
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Questionnaire/Scale
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| Domain Name / Number of Items |
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1) Trunk and upper extremity activities (7)
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2) Respiratory impairment (3)
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| Additional Format Information |
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This is a questionnaire that incorporates 10 items which deal with the patients ability to use wheelchair, ability to transfer from wheelchair, ability to stand, ability to balance in the wheelchair, ability to move the arms, ability to use the hands and arms for eating, ability to turn in bed, ability to cough, ability to speak, and physical well-being.
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| Question Types and Usage |
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Each question has 4 pre-ranked responses that allow the examiner to indicate the level of difficulty involved in performing the task.
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| Total Score |
Yes - total score is calculated.
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| Total Score - Range/Direction |
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| Sub-Score |
Yes - sub-score is calculated.
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| Sub-Score Range/Direction |
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0 = better, 3 = worse in all domains
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Reference 1
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| Reference Details |
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Steffensen, BF. (2002) Functional ability in non-ambulatory people with Duchenne muscular dystrophy or spinal muscular atrophy assessed with the EK scale, Dissertation from the Neurotec Department, Division of Physiotherapy, Karolinska Instituttet, Stockholm (ISBN 91-7349-252-3), Karolinska Instituttet, Stockholm, Sweden
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| Other Information |
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The dissertation is available from the author and from Swedish libraries. It contains studies of reliability, content and construct validity, discriminatory validity, sensitivity to change and predictive validity of the EK scale. Most of these studies are also published as articles in medline cited journals. See other references.
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Reference 2
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| Reference Details |
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Steffensen, BF.; Hyde, S.; Lyager, S.; et al (2001) Validity of the EK scale: a functional assessment of non-ambulatory individuals with Duchenne muscular dystrophy or spinal muscular atrophy; Physiotherapy Research International; Vol 6, pp 119-134, Whurr Publishers Ltd, England
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| Other Information |
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This study examines the content and the discriminatory validity based on a sample of of 56 non ambulatory individuals with DMD and 38 with SMA. The relationship of functional ability measured with EK and muscle strength, FVC, contractures, number of years of wheel-chair dependence and age was examined. All categories and items of EK were valid as means of discriminating between levels of functional performance in the population studied.
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Reference 3
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| Reference Details |
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Lyager S, Steffensen B, Juhl B. Indicators of need for mechanical ventilation in Duchenne muscular dystrophy and spinal muscular atrophy. Chest. 1995 Sep;108(3):779-85.
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| Other Information |
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This study examines the validity of EK as predictor of the need of assisted ventilation (within 1,5 years) among young people with Duchenne muscular dystrophy.
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Reference 4
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Steffensen BF, Lyager S, Werge B, Rahbek J, Mattsson E. Physical capacity in non-ambulatory people with Duchenne muscular dystrophy or spinal muscular atrophy: a longitudinal study. Dev Med Child Neurol. 2002 Sep;44(9):623-32.
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| Other Information |
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This study shows the sensitivity of the EK scale as an instrument to assess changes over time in a 5 years longitudinal study among non-ambulatory subjects with DMD and SMA.
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Reference 5
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Brunherotti MA, Sobreira C, Rodrigues-Júnior AL, de Assis MR, Terra Filho J, Baddini Martinez JA. Correlations of Egen Klassifikation and Barthel Index scores with pulmonary function parameters in Duchenne muscular dystrophy. Heart Lung. 2007 Mar-Apr;36(2):132-9.
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| Other Information |
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This study shows EK as predictor of the need of assisted ventilation among patients with Duchenne muscular dystrophy in a Brazilian setting.
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Reference 6
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Martinez JA, Brunherotti MA, de Assis MR, Sobreira CF. [Validation of the EK functional motor scale in the Portuguese language] Rev Assoc Med Bras. 2006 Sep-Oct;52(5):347-51. Portuguese.
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Translation and use of the EK scale to portuguese as spoken in Brazil.
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Reference 7
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| Reference Details |
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Steffensen BF, Hyde SA, Attermann J, Mattsson E. Reliability of the EK scale, a functional fest for non-ambulatory persons with Duchenne muscular dystrophy. Adv Physiother 4:37-47, 2002.
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| Other Information |
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The study examines reliability of the EK scale in a multidisciplnary setting.
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