Responsiveness of the self-measured 6-minute walking test and the Timed Up and Go test in patients with degenerative lumbar disorders

View More View Less
  • 1 Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich;
  • | 2 Department of Neurosurgery, Kantonsspital St. Gallen; and
  • | 3 Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The 6-minute walking test (6WT) and the Timed Up and Go (TUG) test are two of the most commonly applied standardized measures of objective functional impairment that help support clinical decision-making for patients undergoing surgery for degenerative lumbar disorders. This study correlates smartphone-app–based 6WT and TUG results to evaluate their responsiveness.

METHODS

In a prospective study, 49 consecutive patients were assessed preoperatively and 6 weeks postoperatively using the 6WT, the TUG test, and commonly used patient-reported outcome measures. Raw values and standardized z-scores of both objective tests were correlated. An external criterion for treatment success was created based on the Zurich Claudication Questionnaire patient satisfaction subscale. Internal and external responsiveness for both functional tests was evaluated.

RESULTS

The mean preoperative 6WT results improved from 401 m (SD 129 m), z-score −1.65 (SD 1.6) to 495 m (SD 129 m), z-score −0.71 (SD 1.6, p < 0.001). The mean preoperative TUG test results improved from 10.44 seconds (SD 4.37, z-score: −3.22) to 8.47 seconds (SD 3.38, z-score: −1.93, p < 0.001). The 6WT showed a strong negative correlation with TUG test results (r = −66, 95% CI 0.76–0.53, p < 0.001). The 6WT showed higher internal responsiveness (standardized responsive mean = 0.86) compared to the TUG test (standardized responsive mean = 0.67). Evaluation of external responsiveness revealed that the 6WT was capable of differentiating between patients who were satisfied and those who were unsatisfied with their treatment results (area under the curve = 0.70), whereas this was not evident for the TUG test ( area under the curve = 0.53).

CONCLUSIONS

Both tests adequately quantified functional impairment in surgical candidates with degenerative lumbar disorders. The 6WT demonstrated better internal and external responsiveness compared with the TUG test.

Clinical trial registration no.: NCT03977961 (clinicaltrials.gov)

ABBREVIATIONS

AUC = area under the curve; COMI = Core Outcome Measures Index; DLDs = degenerative lumbar disorders; LDH = lumbar disc herniation; LSS = lumbar spinal stenosis; PROM = patient-reported outcome measure; ROC = receiver operating characteristic; SRM = standardized responsive mean; TUG = Timed Up and Go; VAS = visual analog scale; 6WD = 6-minute walking distance; 6WT = 6-minute walking test; ZCQ = Zurich Claudication Questionnaire.

Supplementary Materials

    • Supplemental Methods, Table, and Figures (PDF 576 KB)
Illustrations from Walker et al. (pp 80–90). © Barrow Neurological Institute, Phoenix, Arizona.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Nicolai Maldaner: University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland. nicolai.maldaner@usz.ch.

INCLUDE WHEN CITING Published online May 7, 2021; DOI: 10.3171/2020.11.SPINE201621.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Gautschi OP, Corniola MV, Schaller K, et al. . The need for an objective outcome measurement in spine surgery—the timed-up-and-go test. Spine J. 2014;14(10):25212522.

    • Search Google Scholar
    • Export Citation
  • 2

    Mannion AF, Fekete TF, Wertli MM, et al. . Could less be more when assessing patient-rated outcome in spinal stenosis?. Spine (Phila Pa 1976). 2015;40(10):710718.

    • Search Google Scholar
    • Export Citation
  • 3

    Mannion AF, Elfering A, Staerkle R, et al. . Outcome assessment in low back pain: how low can you go?. Eur Spine J. 2005;14(10):10141026.

  • 4

    Carragee EJ. The rise and fall of the “minimum clinically important difference”. Spine J. 2010;10(4):283284.

  • 5

    Tomkins-Lane CC, Battié MC. Predictors of objectively measured walking capacity in people with degenerative lumbar spinal stenosis. J Back Musculoskeletal Rehabil. 2013;26(4):345352.

    • Search Google Scholar
    • Export Citation
  • 6

    Stienen MN, Ho AL, Staartjes VE, et al. . Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J. 2019;19(7):12761293.

    • Search Google Scholar
    • Export Citation
  • 7

    Gautschi OP, Smoll NR, Corniola MV, et al. . Validity and reliability of a measurement of objective functional impairment in lumbar degenerative disc disease: the Timed Up and Go (TUG) test. Neurosurgery. 2016;79(2):270278.

    • Search Google Scholar
    • Export Citation
  • 8

    Stienen MN, Gautschi OP, Staartjes VE, et al. . Reliability of the 6-minute walking test smartphone application. J Neurosurg Spine. 2019;31(6):786793.

    • Search Google Scholar
    • Export Citation
  • 9

    Maldaner N, Stienen MN. Subjective and objective measures of symptoms, function, and outcome in patients with degenerative spine disease. Arthritis Care Res (Hoboken). 2020;72(suppl 10):183199.

    • Search Google Scholar
    • Export Citation
  • 10

    Sosnova M, Zeitlberger AM, Ziga M, et al. . Longitudinal smartphone-based self-assessment of objective functional impairment in patients undergoing surgery for lumbar degenerative disc disease: initial experience. Acta Neurochir (Wien). 2020;162(9):20612068.

    • Search Google Scholar
    • Export Citation
  • 11

    Zeitlberger AM, Sosnova M, Ziga M, et al. . Smartphone-based self-assessment of objective functional impairment (6-minute walking test) in patients undergoing epidural steroid injection. Neurospine. 2020;17(1):136142.

    • Search Google Scholar
    • Export Citation
  • 12

    Maldaner N, Sosnova M, Zeitlberger AM, et al. . Evaluation of the 6-minute walking test as a smartphone app–based self-measurement of objective functional impairment in patients with lumbar degenerative disc disease. J Neurosurg Spine. 2020;33(6):779788.

    • Search Google Scholar
    • Export Citation
  • 13

    Stienen MN, Maldaner N, Sosnova M, et al. . External validation of the Timed Up and Go Test as measure of objective functional impairment in patients with lumbar degenerative disc disease. Neurosurgery. 2021;88(2):E142E149.

    • Search Google Scholar
    • Export Citation
  • 14

    Tosic L, Goldberger E, Maldaner N, et al. . Normative data of a smartphone app–based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures. J Neurosurg Spine. 2020;33(4):480489.

    • Search Google Scholar
    • Export Citation
  • 15

    Stienen MN, Maldaner N, Joswig H, et al. . Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus. 2019;46(5):E4.

    • Search Google Scholar
    • Export Citation
  • 16

    Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53(5):459468.

    • Search Google Scholar
    • Export Citation
  • 17

    Gautschi OP, Stienen MN, Corniola MV, et al. . Assessment of the minimum clinically important difference in the Timed Up and Go Test after surgery for lumbar degenerative disc disease. Neurosurgery. 2017;80(3):380385.

    • Search Google Scholar
    • Export Citation
  • 18

    Smuck M, Muaremi A, Zheng P, et al. . Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity. Spine J. 2018;18(1):1521.

    • Search Google Scholar
    • Export Citation
  • 19

    Gautschi OP, Smoll NR, Joswig H, et al. . Influence of age on pain intensity, functional impairment and health-related quality of life before and after surgery for lumbar degenerative disc disease. Clin Neurol Neurosurg. 2016;150:3339.

    • Search Google Scholar
    • Export Citation
  • 20

    Joswig H, Stienen MN, Smoll NR, et al. . Patients’ preference of the Timed Up and Go Test or Patient-Reported Outcome Measures before and after surgery for lumbar degenerative disk disease. World Neurosurg. 2017;99:2630.

    • Search Google Scholar
    • Export Citation
  • 21

    Maldaner N, Tomkins-Lane C, Desai A, et al. . Digital transformation in spine research and outcome assessment. Spine J. 20(2):310-311.

  • 22

    Maldaner N, Desai A, Gautschi OP, et al. . Letter to editor. Improving the patient-physician relationship in the digital era - transformation from subjective questionnaires into objective real-time and patient-specific data reporting tools. Neurospine. 2019;16(4):712714.

    • Search Google Scholar
    • Export Citation
  • 23

    Staartjes VE, Schröder ML. The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. J Neurosurg Spine. 2018;29(4):380387.

    • Search Google Scholar
    • Export Citation
  • 24

    Campbell H, Rivero-Arias O, Johnston K, et al. . Responsiveness of objective, disease-specific, and generic outcome measures in patients with chronic low back pain: an assessment for improving, stable, and deteriorating patients. Spine (Phila Pa 1976). 2006;31(7):815822.

    • Search Google Scholar
    • Export Citation
  • 25

    Stienen MN, Smoll NR, Joswig H, et al. . Validation of the baseline severity stratification of objective functional impairment in lumbar degenerative disc disease. J Neurosurg Spine. 2017;26(5):598604.

    • Search Google Scholar
    • Export Citation
  • 26

    Rainville J, Childs LA, Peña EB, et al. . Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study. Spine J. 2012;12(2):101109.

    • Search Google Scholar
    • Export Citation
  • 27

    Beurskens AJ, de Vet HC, Köke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996;65(1):7176.

    • Search Google Scholar
    • Export Citation
  • 28

    Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials. 1991;12(4)(suppl):142S158S.

    • Search Google Scholar
    • Export Citation
  • 29

    Hyland ME. A brief guide to the selection of quality of life instrument. Health Qual Life Outcomes. 2003;1:24.

  • 30

    Guzman JZ, Cutler HS, Connolly J, et al. . Patient-reported outcome instruments in spine surgery. Spine (Phila Pa 1976). 2016;41(5):429437.

  • 31

    Stienen MN, Rezaii PG, Ho AL, et al. . Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer. Sci Rep. 2020;10(1):4939.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 186 186 61
Full Text Views 36 36 22
PDF Downloads 67 67 45
EPUB Downloads 0 0 0