Nobuyuki Fujita1, Aiko Sakurai2, Azusa Miyamoto3, Takehiro Michikawa4, Yohei Otaka5, Satoshi Suzuki1, Osahiko Tsuji1, Narihito Nagoshi1, Eijiro Okada1, Mitsuru Yagi1, Takashi Tsuji6, Hitoshi Kono7, Ken Ishii8, Masaya Nakamura1, Morio Matsumoto1, Kota Watanabe9. 1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan. 2. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. 3. Keiyu Orthopaedic Hospital, Tatebayashi, Japan. 4. Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan. 5. Department of Rehabilitation Medicine, Fujita Health University, Aichi, Japan. 6. Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan. 7. Keiyu Orthopaedic Hospital, Tatebayashi, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan. 8. Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan. 9. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan. Electronic address: kw197251@keio.jp.
Abstract
BACKGROUND: Short stride length is one of clinical symptoms associated with lumbar spinal stenosis (LSS). Short stride is a risk factor for falls; therefore, identification of factors associated with short stride is critical for fall prevention in LSS patients. Although the Two-Step test can conveniently assess maximal stride length, it has not become widely used; therefore, its data are limited. We identified the potential factors associated with short stride of elderly LSS patients using Two-Step test. METHODS: Clinical data of patients aged >65 years who planned to undergo surgery for LSS were prospectively collected at multiple institutions. Patients were assessed with the Two-Step test and Timed Up-and-Go Test prior to surgery; 357 consecutive patients were enrolled. We determined the cut-off value of the Two-Step test score for short stride, referring to the Timed Up-and-Go Test score of 13.5 s, used to indicate high risk of falls in elderly individuals. Logistic regression model was constructed to identify factors associated with short stride. RESULTS: The Two-Step test score showed moderate-to-strong inverse correlation with that of Timed Up-and-Go Test (r = -0.65, p < 0.001). Using the tentative Two-Step test cut-off value (0.93) for short stride, multivariable analysis showed that age ≥80 years (OR = 2.3, 95% CI:1.1-4.8), a score of <60 for lumbar function in Japanese Orthopedic Association Back Pain Evaluation Questionnaire (OR = 2.7, 95% CI:1.5-4.7), motor deficit (OR = 2.7, 95% CI:1.2-6.1), and sagittal vertical axis ≥50 mm (OR = 2.1, 95% CI:1.2-3.5) were factors significantly associated with short stride in elderly patients with LSS. CONCLUSIONS: Using the Two-Step test, we found that 80 years old and over, lumbar dysfunction, motor deficit of the lower extremities, and forward-bent posture were associated with short stride in LSS patients. Therefore, elderly LSS patients with these conditions may have a higher risk for falls.
BACKGROUND: Short stride length is one of clinical symptoms associated with lumbar spinal stenosis (LSS). Short stride is a risk factor for falls; therefore, identification of factors associated with short stride is critical for fall prevention in LSS patients. Although the Two-Step test can conveniently assess maximal stride length, it has not become widely used; therefore, its data are limited. We identified the potential factors associated with short stride of elderly LSS patients using Two-Step test. METHODS: Clinical data of patients aged >65 years who planned to undergo surgery for LSS were prospectively collected at multiple institutions. Patients were assessed with the Two-Step test and Timed Up-and-Go Test prior to surgery; 357 consecutive patients were enrolled. We determined the cut-off value of the Two-Step test score for short stride, referring to the Timed Up-and-Go Test score of 13.5 s, used to indicate high risk of falls in elderly individuals. Logistic regression model was constructed to identify factors associated with short stride. RESULTS: The Two-Step test score showed moderate-to-strong inverse correlation with that of Timed Up-and-Go Test (r = -0.65, p < 0.001). Using the tentative Two-Step test cut-off value (0.93) for short stride, multivariable analysis showed that age ≥80 years (OR = 2.3, 95% CI:1.1-4.8), a score of <60 for lumbar function in Japanese Orthopedic Association Back Pain Evaluation Questionnaire (OR = 2.7, 95% CI:1.5-4.7), motor deficit (OR = 2.7, 95% CI:1.2-6.1), and sagittal vertical axis ≥50 mm (OR = 2.1, 95% CI:1.2-3.5) were factors significantly associated with short stride in elderly patients with LSS. CONCLUSIONS: Using the Two-Step test, we found that 80 years old and over, lumbar dysfunction, motor deficit of the lower extremities, and forward-bent posture were associated with short stride in LSS patients. Therefore, elderly LSS patients with these conditions may have a higher risk for falls.