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

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The 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.


Patients 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.


Our 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.


The 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.

ABBREVIATIONS BSS = baseline severity stratification; DDD = degenerative disc disease; HRQOL = health-related quality of life; LDH = lumbar disc herniation; LSS = lumbar spinal stenosis; MCID = minimum clinically important difference; OFI = objective functional impairment; PROM = patient-reported outcome measure; RC = regression coefficient; RMDQ = Roland-Morris Disability Questionnaire; TUG = timed-up-and-go; VAS = visual analog scale; 5R-STS = five-repetition sit-to-stand; 6WT = six-minute walking test.

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Contributor Notes

Correspondence Victor E. Staartjes: Bergman Clinics, Naarden, The Netherlands. victor.staartjes@gmail.com.INCLUDE WHEN CITING Published online February 21, 2020; DOI: 10.3171/2019.12.SPINE191124.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


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