Dear Editor, We read with interest the article “One year post intervention health related physical fitness and quality of life among children and grown up with congenital heart disease,” which addresses an important evidence gap from an Indian tertiary care setting.1 The prospective design, the use of a disease-specific quality-of-life instrument, and the inclusion of objective health-related physical fitness (HRPF) measures are notable strengths. My main comments relate to outcome measurement and interpretation. The use of the PedsQL 3.0 Cardiac Module is appropriate and in line with contemporary psychometric work in adolescents with congenital heart disease, where this module has shown good reliability, validity, and responsiveness.2 However, the manuscript states that higher transformed PedsQL scores represent poorer health-related quality of life and interprets all results accordingly. Standard PedsQL scoring reverses item responses and transforms them to a 0-100 metric such that higher scores indicate better health-related quality of life.3 This conceptual inversion does not change the direction of within-study change over time, but it hampers comparability with published PedsQL norms, disease-specific studies, and established minimal important differences, and may confuse readers who are familiar with the usual scoring convention. Explicitly acknowledging and reconciling this difference would strengthen interpretability. For HRPF, the choice of the FITNESSGRAM framework is another strength, as it is the most widely implemented criterion-referenced battery for health-related fitness in youth and is supported by a detailed reference guide and extensive validation work.4,5 In the present study, however, several ad hoc tasks were added or adapted for children aged 2–5 years, and it is not clear whether standard FITNESSGRAM protocols, age ranges, and cut points were adhered to for all components. Since the validity of FITNESSGRAM classifications depends on standardized test administration and age-appropriate thresholds,4,5 these modifications should be more fully justified, and results for very young children interpreted as exploratory rather than directly comparable with FITNESSGRAM-based benchmarks. Finally, age- and sex-matched controls were recruited “at both time points,” but it is not explicit whether the same controls were followed longitudinally or whether two independent control samples were used. Clarification would help readers understand whether group-by-time comparisons reflect true longitudinal differences or repeated cross-sections. In addition, multiple tests were conducted across six age strata, numerous FITNESSGRAM components, and six PedsQL domains without any apparent adjustment for multiplicity, which may increase the probability of chance findings. The study provides valuable data on postintervention recovery of HRPF and health-related quality of life in congenital heart disease. Clearer alignment with established scoring conventions for PedsQL and with standardized FITNESSGRAM protocols would further enhance the robustness and comparability of its conclusions. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Sharma et al. (2026) studied this question.