EK scale
The EK scale was developed by RCFM co-founder, physiotherapist, PhD Birgit Steffensen as an instrument to measure changes – even small ones – in physical function over time in wheelchair users with spinal muscular atrophy and Duchenne muscular dystrophy.
The scale is based on interviews in which the person in question accounts for his or her functional capacity. The name EK stands for egenklassifikation meaning self classification.
EK scale in DanishDevelopment of EK 1
The EK1-10 was developed and constructed by Dr Birgit Steffensen et al; studies on reliability and validity were published 1995-2002 [1,2,3,4]. The EK1-10 is very responsive to change in persons with DMD [5].
The scale is a composite scale consisting of 10 items; each item is scored in four categories from 0 to 3 based on a face-to-face interview with the person about how the individual items are normally performed. If possible, the person is asked to demonstrate the performance. The EK-sum score is calculated as the sum of all items; maximum score (30) represents lowest function, and minimum score (0) represents highest function.
A more sensitive scale (EK2)
Since the EK1-10 was not as sensitive to change over time in individuals with SMA as in individuals with DMD, the EK scale was expanded to EK2 1-17 by an international expert group . Seven items representing abilities related to hand-function, eating and swallowing were added to the original scale [6]. The scoring by four categories and the revised score with 0 as highest function is the same as for EK1, but the maximum EK2-sum score is 51.
The EK scale is used worldwide and has been translated into and validated in several languages.
The content validity, reliability and discriminatory power of EK2 was good, meaning that the categories of EK 17 have stronger explanatory power than the categories of Ek 1-10 in a non-ambulant population of persons with SMA
References
1. Lyager S, Steffensen B, Juhl B. Indicators of Need for Mechanical Ventilation in Duchenne Muscular Dystrophy and Spinal Muscular Atrophy.Chest 1995;108:779-785.
2. Steffensen B, Hyde S, Lyager S, Mattsson E. Validity of the EK scale: a functional assessment of non-ambulatory individuals with Duchenne muscular dystrophy or spinal muscular atrophy. Physiotherapy Research International, 6(3) 119–134, 2001.
3. 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; 44:623-32.
4. Steffensen BF, Hyde S, Attermann J, Mattsson E. Reliability of the EK Scale, a Functional Test for Non-ambulatory Persons with Duchenne Dystrophy. Advances in Physiotherapy 2002; 4:37-47.
5. Connolly AM et al. Clinical trial readiness in non-ambulatory boys and men with Duchenne muscular dystrophy: MDA-DMD network follow-up. Muscle Nerve 2016; 54: 681-689.
6. Steffensen BF, Mayhew A, Aloysius A, et al. Egen Classification revisited in SMA. Neromuscul Disord 2008; 18: 740-41.
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This version of the EK scale in Arabic was translated by the medical company Santhera for use in a medical study.
The translation from English to Arabic was done by professional translators and subesquently validated by an English-speaking expert in NMD.
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Translated and validated by Daniele Botiková Department of Rehabilitation of the University Hospital Brno Contact: Botikova.Daniela@fnbrno.cz
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This Dutch version of the EK scale was translated by the medical company Santhera for use in a medical study.
The translation from English to Dutch was done by professional translators and subesquently validated by an English-speaking expert in NMD.
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The English version of the EK1-10 scale was first published in Physiotherapy Research International 2001, EK-validity study.
During the development of the EK scale, the scale proved to be an indicator of the need for mechanical ventilation in persons with DMD. This study was published in Chest 1995
The EK2 was expanded with seven items to make the scale more sensitive to changes in SMA, and the study was presented as a poster presentation at WMS 2008. The manual was updated by Anna Mayhew PT, PhD, Newcastle University.
You can download the EK2 scale and the EK2 manual below. The manual has been revised may 2018, by Dr Anna Mayhew and Meredith James from the John Walton Muscular Dystrophy Research Centre and Dr Ulla Werlauff from the National Rehabilitation Centre for Neuromuscular Diseases, Denmark.
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This French version of the EK scale was translated by the medical company Santhera for use in a medical study.
The translation from English to French was done by professional translators and subesquently validated by an English-speaking expert in NMD.
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This German version of the EK scale was translated by the medical company Santhera for use in a medical study.
The translation from English to German was done by professional translators and subesquently validated by an English-speaking expert in NMD.
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Translated and validated by Elena Mazzone Department of Child Neurology, Catholic University in Rome, Rome, Italy Contact: esmazzone@gmail.com>
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Martinez JAB, Runherotti MA, De Assis MR et al. Validacao da escala motora functional EK para a lingua Portuguesa. Rev Assoc Med Bras 2006; 52(5): 347-51 Contact: jabmarti@fmrp.usp.br
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The Scale – Escala-EK2
Fagoaga J, Girabent-Farrés M, Bagur-Calafat C, Febrer A, Steffensen BF. Translation and validation of the Egen Klassifikation scale for the Spanish population: functional assessment for non-ambulatory individuals with Duchenne’s muscular dystrophy and spinal muscular atrophy. Rev Neurol. 2013 Jun 1;56(11):555-61. Link to article
Fagoaga J, Girabent-Farrés M, Bagur-Calafat C, Steffensen BF.Evolution of functional capacity, assessed with the Egen Klassifikation scale, in the Spanish population with spinal muscular atrophy or Duchenne muscular dystrophy. A three year longitudinal study. Rev Neurol. 2013 Jun 1;56(11):555-61. Link to article
Fagoaga J, Girabent-Farrés M, Bagur-Calafat C, Febrer A, Steffensen BF. Evaluación funcional para personas no ambulantes afectas de atrofia muscular espinal y distrofia muscular de Duchenne. Traducción y validación de la escala Egen Klassifikation 2 para la población española. Rev Neurol 2015; 60 (10): 439-446 – Link to article in Revista de Neurología
Manual del Usuario para la escala EK2
Contact : joaquinfagoaga@gmail.com
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Oversättning: Elisabet Hammarén, 2018 Kontakt: elisabet.hammaren@vgregion.se
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Contact: aykaradu@hacettepe.edu.tr
Translations in progress
Japanese version
Contact: shigemori@ncnp.go.jp
Mexican version
Contact: ian12_rm619@hotmail.com
Hebrew version
Contact: Lynette.Aleman@tribeclinical.com
Arabic version
Contact: Lynette.Aleman@tribeclinical.com
Studies that have used the EK scale
SMA studies
Change in muscle strength over time in spinal muscular atrophy type II
DMD studies
Correlation of EK and Barthel Index score
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Ulla Werlauff
Head of research, physical therapist, MSc, ph.d
ulwe@rcfm.dk- Project management and supervisionLæs mere
- Measurement instruments
- Method
- Education
