Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review

Jespersen, Annette Bennedsgaard; Gustafsson, Malin Eleonora av Kák

doi:10.1007/s00586-018-5520-5

Cited by 25 publications

(22 citation statements)

References 61 publications

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“…The SPWT has previously been described as the "gold standard" of objective outcome measurement in patients with LSS. 22,45 Patients are instructed to walk continuously at their own pace around an indoor 200-meter track until they have to stop or until a maximum time of 30 minutes. Its test-retest reliability was excellent (intraclass correlation coefficient = 0.98).…”

Section: Discussionmentioning

confidence: 99%

Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis

Stienen

Maldaner

Joswig

et al. 2019

Neurosurgical Focus

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OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the “Timed Up and Go” (TUG) test. Currently, only a few studies report pre- and postoperative TUG test assessments in patients with lumbar spinal stenosis (LSS).METHODSA prospective two-center database was reviewed to identify patients with LSS who underwent lumbar decompression with or without fusion. The subjective functional status was estimated using PROMs for pain (visual analog scale [VAS]), disability (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQoL; 12-Item Short-Form Physical Component Summary [SF-12 PCS] and the EQ-5D) preoperatively, as well as on postoperative day 3 (D3) and week 6 (W6). Objective functional impairment (OFI) was measured using age- and sex-standardized TUG test results.RESULTSSixty-four patients (n = 32 [50%] male, mean age 66.8 ± 11.7 years) were included. Preoperatively, they reported a mean VAS back pain score of 4.1 ± 2.7, VAS leg pain score of 5.4 ± 2.7, RMDI of 10.4 ± 5.3, ODI of 41.9 ± 16.2, SF-12 PCS score of 32.7 ± 8.3, and an EQ-5D index of 0.517 ± 0.226. The preoperative rates of severe, moderate, and mild OFI were 4.7% (n = 3), 12.5% (n = 8), and 7.8% (n = 5), respectively, and the mean OFI T-score was 116.3 ± 23.7. At W6, 60 (93.8%) of 64 patients had a TUG test result within the normal population range (no OFI); 3 patients (4.7%) had mild and 1 patient (1.6%) severe OFI. The mean W6 OFI T-score was significantly decreased (103.1 ± 13.6; p < 0.001). Correspondingly, the PROMs showed a decrease in subjective VAS back pain (1.6 ± 1.7, p < 0.001) and leg pain (1.0 ± 1.8, p < 0.001) scores, disability (RMDI 5.3 ± 4.7, p < 0.001; ODI 21.3 ± 16.1, p < 0.001), and increase in HRQoL (SF-12 PCS 40.1 ± 8.3, p < 0.001; EQ-5D 0.737 ± 0.192, p < 0.001) at W6. The W6 responder status (clinically meaningful improvement) ranged between 81.3% (VAS leg pain) and 29.7% (EQ-5D index) of patients.CONCLUSIONSThe TUG test is a quick and easily applicable tool that reliably measures OFI in patients with LSS. Objective tests incorporating longer walking time should be considered if OFI is suspected but fails to be proven by the TUG test, taking into account that neurogenic claudication may not clinically manifest during the brief TUG examination. Objective tests do not replace the subjective PROM-based assessment, but add valuable information to a comprehensive patient evaluation.

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Section: Discussionmentioning

confidence: 99%

Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis

Stienen

Maldaner

Joswig

et al. 2019

Neurosurgical Focus

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“…Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation walking performance; used in conjunction with the walking test (10,11). There have been multiple case studies on the effectiveness of wearable accelerometers post spinal surgery, for instance recovery post minimally invasive fusion (9).…”

Section: Case Reportmentioning

confidence: 99%

“…However, the major problem in utilizing these scores is their subjectivity and the inherent bias with self-appraisal, as different individuals perceive and tolerate pain differently (9). Recent literature states that the ODI should not be a stand-alone tool for evaluating walking limitation in patients with lumbar spinal stenosis (10). For comprehensive assessment of walking ability, an objective walking test should be utilized in order to assess walking capacity.…”

Section: Introductionmentioning

confidence: 99%

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

Mobbs¹,

Katsinas²,

Choy³

et al. 2018

J Spine Surg

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We report a case of a 39-year-old male with sciatica who underwent an L5/S1 microdiscectomy with objective physical activity measurements performed preoperatively and continually postoperatively up to 3-month using wireless accelerometer technology linked to the surgical practice; collecting distance travelled, daily step count (DSC) and Gait Velocity (GV). Preoperative, the patient was walking with a GV of 0.97 m/s and a DSC of less than 2,500. After the first month following surgery, the patient had increased mobility, with a GV of 1.58 m/s, and taking an average of over 4,500 steps per day. At day 57 postop, the patient experienced a recurrence of pain with reduction of GV, DSC and walking distance. Magnetic resonance imaging (MRI) was performed and revealed a recurrent disc herniation with further surgery on day 63, with a rapid return of function post 2 nd surgery. The use of wireless accelerometers is practical in obtaining objective physical activity measurements before and after lumbar microdiscectomy, and will assist the surgeon and rehabilitation provider to monitor outcomes, complications and assist in clinical decision making.

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“…It is commonly used to provide a patient-reported measure of walking limitation and other functional limitations in LSS trials, alongside objective measures of walking ability. 33 The ODI comprises a series of questions about how pain impacts on the patient's ability to carry out a range of daily functions. For each question, possible answers are scored on a scale of 0-5.…”

Section: Discussionmentioning

confidence: 99%

“…It is commonly used to provide a patient-reported measure of walking limitation and other functional limitations in LSS trials, alongside objective measures of walking ability. 33 …”

Section: Methods and Analysesmentioning

confidence: 99%

Understanding the mechanisms of a combined physical and psychological intervention for people with neurogenic claudication: protocol for a causal mediation analysis of the BOOST trial

et al. 2020

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IntroductionConservative treatments such as exercise are recommended for the management of people with neurogenic claudication from spinal stenosis. However, the effectiveness and mechanisms of effect are unknown. This protocol outlines an a priori plan for a secondary analysis of a multicentre randomised controlled trial of a physiotherapist-delivered, combined physical and psychological intervention (Better Outcomes for Older people with Spinal Trouble (BOOST) programme).Methods and analysesWe will use causal mediation analysis to estimate the mechanistic effects of the BOOST programme on the primary outcome of disability (measured by the Oswestry Disability Index). The primary mechanism of interest is walking capacity, and secondary mediators include fear-avoidance behaviour, walking self-efficacy, physical function, physical activity and/or symptom severity. All mediators will be measured at 6 months and the outcome will be measured at 12 months from randomisation. Patient characteristics and possible confounders of the mediator-outcome effect will be measured at baseline. Sensitivity analyses will be conducted to evaluate the robustness of the estimated effects to varying levels of residual confounding.Ethics and disseminationEthical approval was given on 3 March 2016 (National Research Ethics Committee number: 16/LO/0349). The results of this analysis will be disseminated in peer-reviewed journals and at relevant scientific conferences.Trial registration numberISRCTN12698674.

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Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review

Cited by 25 publications

References 61 publications

Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis

Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis

Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation

Understanding the mechanisms of a combined physical and psychological intervention for people with neurogenic claudication: protocol for a causal mediation analysis of the BOOST trial

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