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

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  • 1 Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich;
  • 2 Department of Neurosurgery, Kantonsspital St. Gallen; and
  • 3 Neurological and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
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OBJECTIVE

Digital transformation enables new possibilities to assess objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). This study examines the psychometric properties of an app-based 6-minute walking test (6WT) and determines OFI in patients with lumbar DDD.

METHODS

The maximum 6-minute walking distance (6WD) was determined in patients with lumbar DDD. The results were expressed as raw 6WDs (in meters), as well as in standardized z-scores referenced to age- and sex-specific values of spine-healthy volunteers. The 6WT results were assessed for reliability and content validity using established disease-specific patient-reported outcome measures.

RESULTS

Seventy consecutive patients and 330 volunteers were enrolled. The mean 6WD was 370 m (SD 137 m) in patients with lumbar DDD. Significant correlations between 6WD and the Core Outcome Measures Index for the back (r = −0.31), Zurich Claudication Questionnaire (ZCQ) symptom severity (r = −0.32), ZCQ physical function (r = −0.33), visual analog scale (VAS) for back pain (r = −0.42), and VAS for leg pain (r = −0.32) were observed (all p < 0.05). The 6WT revealed good test-retest reliability (intraclass correlation coefficient 0.82), and the standard error of measurement was 58.3 m. A 4-tier severity stratification classified patients with z-scores > −1 (no OFI), −1 to −1.9 (mild OFI), −2 to −2.9 (moderate OFI), and ≤ −3 (severe OFI).

CONCLUSIONS

The smartphone app-based self-measurement of the 6WT is a convenient, reliable, and valid way to determine OFI in patients with lumbar DDD. The 6WT app facilitates the digital evaluation and monitoring of patients with lumbar DDD.

ABBREVIATIONS COMI = Core Outcome Measures Index; DDD = degenerative disc disease; ICC = intraclass correlation coefficient; LBP = low-back pain; LDH = lumbar disc herniation; LLN = lower limit of normal; LSS = lumbar spinal stenosis; OFI = objective functional impairment; PROM = patient-reported outcome measure; SPWT = self-paced walking test; TUG = Timed-Up-and-Go; VAS = visual analog scale; ZCQ = Zurich Claudication Questionnaire; 5R-STS = Five-Repetition Sit-to-Stand; 6WD = 6-minute walking distance; 6WT = 6-minute walking test.

Supplementary Materials

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Contributor Notes

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

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.SPINE20547.

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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