Michael Grelat1, Anaïs Gouteron2, Jean-Marie Casillas3, Baptiste Orliac2, Jacques Beaurain4, Isabelle Fournel5, Davy Laroche3. 1. Neurosurgery Department, Technological Investigation Platform, University Hospital of Dijon, Dijon, France; CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon, Dijon, France. Electronic address: michael.grelat@gmail.com. 2. INSERM UMR 1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, Dijon, France. 3. CIC INSERM 1432, Technological Investigation Platform, University Hospital of Dijon, Dijon, France; INSERM UMR 1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, Dijon, France. 4. Neurosurgery Department, Technological Investigation Platform, University Hospital of Dijon, Dijon, France. 5. INSERM CIC 1432, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France.
Abstract
OBJECTIVE: The main objective was to compare estimated walking perimeter (WP) and actual WP during a free walking test (6-minute walk test [6MWT]) in patients with lumbar spinal stenosis (LSS). The second objective was to describe the correlation between measured gait parameters and functional parameters. METHODS: This was a single-center prospective study including 38 patients with symptomatic LSS (23 men, 15 women; mean age, 69.3 ± 7.9 years). The intervention was the 6MWT. For the main outcome measure, patients were first asked to verbally estimate their WP. Then, WP was evaluated using a 6MWT at a self-selected speed. In the absence of need to stop, and if a distance of 500 m was not reached, the test was extended to this distance. Specific functional scores (Oswestry Disability Index and Quebec Back Pain Disability Scale) were recorded, and a quality of life questionnaire was completed. RESULTS: WP was estimated to be less than 500 m in 21 of 38 patients, but only 7 patients actually stopped walking before reaching 500 m. The median estimate error in these patients was 200 m (interquartile range, 65-250). The shorter the estimated distance was, the greater the estimation error (r = -0.63, P=0.002). The average walking speed was slow. Functional parameters (Oswestry Disability Index and Quebec Back Pain Disability Scale) were weakly and inversely correlated with real WP (r = -0.44 and r = -0.31, respectively) and moderately inversely correlated with measured walking speed (r = -0.51, P = 0.001 for both). CONCLUSIONS: Direct measurement of free walking speed should be considered as a valid functional assessment in current practice for patients with LSS instead of estimated WP. To assist therapeutic decision-making, the most relevant type of walking test (duration, distance, velocity) needs to be determined.
OBJECTIVE: The main objective was to compare estimated walking perimeter (WP) and actual WP during a free walking test (6-minute walk test [6MWT]) in patients with lumbar spinal stenosis (LSS). The second objective was to describe the correlation between measured gait parameters and functional parameters. METHODS: This was a single-center prospective study including 38 patients with symptomatic LSS (23 men, 15 women; mean age, 69.3 ± 7.9 years). The intervention was the 6MWT. For the main outcome measure, patients were first asked to verbally estimate their WP. Then, WP was evaluated using a 6MWT at a self-selected speed. In the absence of need to stop, and if a distance of 500 m was not reached, the test was extended to this distance. Specific functional scores (Oswestry Disability Index and Quebec Back Pain Disability Scale) were recorded, and a quality of life questionnaire was completed. RESULTS: WP was estimated to be less than 500 m in 21 of 38 patients, but only 7 patients actually stopped walking before reaching 500 m. The median estimate error in these patients was 200 m (interquartile range, 65-250). The shorter the estimated distance was, the greater the estimation error (r = -0.63, P=0.002). The average walking speed was slow. Functional parameters (Oswestry Disability Index and Quebec Back Pain Disability Scale) were weakly and inversely correlated with real WP (r = -0.44 and r = -0.31, respectively) and moderately inversely correlated with measured walking speed (r = -0.51, P = 0.001 for both). CONCLUSIONS: Direct measurement of free walking speed should be considered as a valid functional assessment in current practice for patients with LSS instead of estimated WP. To assist therapeutic decision-making, the most relevant type of walking test (duration, distance, velocity) needs to be determined.
Authors: Jamie Arjun Sharma; Pravesh S Gadjradj; Wilco C Peul; Maurits W van Tulder; Wouter A Moojen; Biswadjiet S Harhangi Journal: BMJ Open Date: 2020-10-06 Impact factor: 2.692