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Neurosurg Focus. 2019 May 1;46(5):E4. doi: 10.3171/2019.2.FOCUS18618.

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

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1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich.
2Department of Neurosurgery, Cantonal Hospital St. Gallen.
3Department of Clinical Neuroscience, Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, Geneva; and.
4Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland.


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.


6WD = 6-minute walking distance; 6WT = 6-minute walking test; CCI = Charlson Comorbidity Index; D3 = day 3; DDD = degenerative disc disease; HRQoL = health-related quality of life; LSS = lumbar spinal stenosis; MCID = minimum clinically important difference; MCS = Mental Component Summary; MTT = motorized treadmill test; ODI = Oswestry Disability Index; OFI = objective functional impairment; PCS = Physical Component Summary; PROM = patient-reported outcome measure; RMDI = Roland-Morris Disability Index; SF-12 = 12-Item Short-Form; SPWT = self-paced walking test; SWT = shuttle walking test; TUG; TUG = Timed Up and Go; Timed Up and Go test; VAS = visual analog scale; W6 = week 6; lumbar spinal stenosis; objective functional impairment; objective measure of function; outcome assessment


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