External Validation of the Timed Up and Go Test as Measure of Objective Functional Impairment in Patients With Lumbar Degenerative Disc Disease

Abstract

BACKGROUND The Timed Up and Go (TUG) test is the most commonly applied objective measure of functional impairment in patients with lumbar degenerative disc disease (DDD). OBJECTIVE To demonstrate external content validity of the TUG test. METHODS Consecutive adult patients, scheduled for elective lumbar spine surgery, were screened for enrollment into a prospective observational study. Disease severity was estimated by patient-reported outcome measures (PROMs; Visual Analog Scales [VAS], Core Outcome Measures Index [COMI] back, Zurich Claudication Questionnaire [ZCQ]) and the TUG test. Pearson correlation coefficients (PCCs) were used to describe the relationship between logarithmic TUG test raw values and PROMs RESULTS A total of 70 patients (mean age 55.9 ± 15.4 yr; 38.6% female; 27.1% previous spine surgery; 28.6% lower extremity motor deficits) with lumbar disc herniation (50%), lumbar spinal stenosis (34.3%), or instability requiring spinal fusion (15.7%) were included. The mean TUG test time was 10.8 ± 4.4 s; age- and sex-adjusted objective functional impairment (OFI) T-score was 134.2 ± 36.9. A total of 12 (17.1%) patients had mild, 14 (20%) moderate, and 9 (12.9%) severe OFI, while 35 (50%) had TUG test results within the normal population range (no OFI). PCCs between TUG test time and VAS back pain were r = 0.37 (P = .002), VAS leg pain r = 0.37 (P = .002), COMI back r = 0.50 (P < .001), ZCQ symptom severity r = 0.41 (P < .001), and ZCQ physical function r = 0.36 (P = .002). CONCLUSION This external validation demonstrated similar OFI rates and PCCs between logarithmic TUG test results and PROMs compared to the original article from 2016. These findings support the TUG test being a quick, easy-to-use objective test, which provides the physician with a robust estimate of pain and functional impairment.

Distance to first symptoms measured by the 6-min walking test differentiates between treatment success and failure in patients with degenerative lumbar disorders

“…Overall, the results showed a moderate inverse correlation of changes in walking distances (6WD and DTFS) to subjective measures, indicating that patients with more pain and/or disability walked shorter distances without relevant symptoms. In line with our findings, previous studies have shown a weak to moderate correlation of different objective outcome measures, like the timed up-and-go (TUG) test or the motorized treadmill test (MTT), with PROMs [20,21]. Subjective and objective assessments in lumbar DLD patients do not seem to always align in a linear fashion, indicating that the 6WT is not a mere objectification of PROM questionnaires and should be considered a separate dimension in the outcome assessment of spine patients [6].…”

External Validation of the Minimum Clinically Important Difference in the Timed-up-and-go Test After Surgery for Lumbar Degenerative Disc Disease

“…The increasing use of the TUG test as an objective measure of function in published articles points to its value as a brief functional test in patients with lumbar DDD 1,7,22,23 Previous reports have demonstrated the TUG test's excellent intra-rater (97%) and inter-rater reliability (99%) with a low error of measurement in different patient populations. 12,13 Since its introduction in the late 80 s by Jaeschke et al, the concept of MCID has become a cornerstone in the evaluation of the psychometric properties of an outcome measurement in spine surgery. 24 This is true both for PROMs as well as for objective measures of function, where it is crucial to determine that a specific change in OFI can be considered as clinically meaningful with confidence.…”

“…NYHA III, lung cancer, and diffuse parenchymal lung disease) or other medical reasons interfering with the patient's ability to walk and perform the TUG test. 13 A patient flow chart is depicted in Supplemental Figure 1, http://links.lww.com/BRS/B777. According to the original study by Gautschi et al, all assessments were conducted before, usually on the day before the scheduled surgery, and around 6 weeks postoperative (W6).…”

“…1 Its excellent reliability and validity has been confirmed in different patient populations and test results can be standardized for age-and sex-related differences using a free smartphone application (app). [11][12][13] It is increasingly acknowledged in the evaluation of spine outcomes that minor pre-to postoperative changes in function may not necessarily be clinically meaningful. The concept of the minimum clinically important difference (MCID) has been established to define treatment success for both PROMs and objective outcome measures alike.…”

Reabilitação ambulatorial da COVID longa: uma chamada à ação

“…69 It has been used in several populations with and without disabilities. [70][71][72][73][74] Reference values vary from age groups and populations, 75,76 however, robust data on long COVID patients hospitalized due to moderate or severe COVID-19 is still limited in the literature.…”