Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study

Staartjes, Victor E.; Beusekamp, Femke; Schröder, Marc

doi:10.1007/s00586-019-05897-3

Cited by 25 publications

(22 citation statements)

References 31 publications

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“…11 The simplicity of the 5R-STS test and the relative quickness with which it can be conducted is advantageous for patients, who can perform it and even monitor their functional state at home. 15,29 Using the 5R-STS test alongside conventional PROMs has the potential to be of great benefit in the assessment of patients with degenerative pathologies of the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

“…Even though a sufficient interrater agreement of the test was already calculated previously in many populations, this variable may have had an influence on the reliability of the 5R-STS test. 6,14,21,29…”

Section: Limitationsmentioning

confidence: 99%

“…15 Overall, the quick completion, good reliability, and straightforward interpretation of tests for objective functional impairment (OFI) have the potential to be of great benefit when these tests are used alongside PROMs. 16,29,32 The 5R-STS test has recently been used to examine patients with degenerative pathologies of the lumbar spine. 30 Previously, this test had already been successfully used in patients with other disorders, such as stroke, chronic obstructive pulmonary disease, and Parkinson's disease, but the literature on its utilization in the care of patients with degenerative spinal pathologies remains limited.…”

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confidence: 99%

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Objective functional impairment in lumbar degenerative disease: concurrent validity of the baseline severity stratification for the five-repetition sit-to-stand test

Klukowska

Schröder

Stienen

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe five-repetition sit-to-stand (5R-STS) test provides a new dimension of clinical assessment by capturing objective functional impairment (OFI). Through the utilization of data from two prospective studies, the authors sought to evaluate the concurrent validity of the proposed 5R-STS baseline severity stratification (BSS) for OFI with the following levels based on time to completion in seconds: none, ≤ 10.4; mild, 10.5–15.2; moderate, 15.3–22.0; and severe, > 22.0 seconds.METHODSPatients with degenerative diseases of the spine performed the 5R-STS test and completed visual analog scales (VASs) for back and leg pain, the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMDQ), and EQ-5D questionnaires. The degree of OFI severity was assessed based on the previously proposed BSS, and its association with patient-reported scales was evaluated using ANOVA as well as crude and adjusted linear regression models.RESULTSOur sample included 240 patients, of whom 101 exhibited no OFI, whereas 80, 34, and 25 were judged to have mild, moderate, and severe OFI, respectively. A higher baseline severity was strongly associated with loss of working ability (p < 0.001), as well as results of all patient-reported scales (p ≤ 0.001), with the exception of the VAS for leg pain (p = 0.556). Crude and adjusted regression analyses corroborated these findings, although only patients with moderate and severe OFI as judged by using the 5R-STS BSS demonstrated clinically relevant differences compared with patients without OFI.CONCLUSIONSThe degree of OFI—based on the 5R-STS BSS—is strongly associated with measures of back pain, subjective functional impairment, and health-related quality of life. However, leg pain severity is not reflected within the dimension of OFI measured by the 5R-STS. The proposed BSS appears to be a concurrently valid and clinically relevant measure of OFI in patients with degenerative spinal pathologies.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Objective functional impairment in lumbar degenerative disease: concurrent validity of the baseline severity stratification for the five-repetition sit-to-stand test

Klukowska

Schröder

Stienen

et al. 2020

Journal of Neurosurgery: Spine

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“…29 Third, self-measurements are possible in the patient's home environment, thereby empowering patients to monitor their own outcomes and be active partners in healthcare. 3,30 It was reported that, compared to PROMs, objective functional tests such as the TUG test better account for disability resulting from lower-extremity motor deficits. 31 Also, we noticed that patients consistently overrate their functional recovery on subjective PROMs in the early postoperative period, whereas the objective assessment lags behind and may reflect the situation with approach-related muscle and wound pain more realistically.…”

Section: Why Use Ofi In Daily Clinical Patient Care?mentioning

confidence: 99%

Normative data of a smartphone app–based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures

Tosic

Goldberger

Maldaner

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe 6-minute walking test (6WT) is used to determine restrictions in a subject’s 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements.METHODSThe maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16–91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3–40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs.RESULTSThe ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87–0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7–597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001).CONCLUSIONSThis study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.

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“…The TUG test does not require any special equipment except for a chair, a timer, and 3 meters of unrestricted walking space. It is currently recommended that an examiner takes the patient's time; however, patient self‐measurements have been found to be reliable for similar objective functional tests . Walking aids (cane, walker, etc) are permitted if required.…”

Section: Timed Up‐and‐go Testmentioning

confidence: 99%

Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease

Maldaner

Stienen

2020

Arthritis Care & Research

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Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study

Cited by 25 publications

References 31 publications

Objective functional impairment in lumbar degenerative disease: concurrent validity of the baseline severity stratification for the five-repetition sit-to-stand test

Objective functional impairment in lumbar degenerative disease: concurrent validity of the baseline severity stratification for the five-repetition sit-to-stand test

Normative data of a smartphone app–based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures

Subjective and Objective Measures of Symptoms, Function, and Outcome in Patients With Degenerative Spine Disease

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