Hiroto Takenaka1, Hideshi Sugiura2, Mitsuhiro Kamiya3, Kasuri Nishihama4, Atsuki Ito4, Junya Suzuki4, Morio Kawamura5, Shuntaro Hanamura3, Hirokatsu Hanamura3. 1. Department of Rehabilitation, Asahi Hospital, 2090 Higashino-cho, Kasugai, Aichi 486-0819, Japan; Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan. Electronic address: hiroto.takenaka@gmail.com. 2. Department of Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan. 3. Department of Orthopedic Surgery, Asahi Hospital, 2090 Higashino-cho, Kasugai, Aichi 486-0819, Japan. 4. Department of Rehabilitation, Asahi Hospital, 2090 Higashino-cho, Kasugai, Aichi 486-0819, Japan. 5. Department of Physical Therapy, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi 487-8501, Japan.
Abstract
BACKGROUND CONTEXT: Few studies have investigated predictors of objective walking distance in patients with lumbar spinal stenosis (LSS). PURPOSE: This study aimed to clarify objective predictors of postoperative 6-minute walk distance (6MWD) in patients with LSS and to develop prediction equations. STUDY DESIGN: This was a prospective study. Data were analyzed by multiple linear regression analyses. PATIENT SAMPLE: Patients with LSS were enrolled. OUTCOME MEASURES: Predictors of 6MWD after surgery were evaluated, including patient characteristics (sex, age, height, and body weight), pain (visual analog scale; low back pain, lower limb pain, and lower limb numbness), surgical factors (number of operation segments [1 or ≥2], surgery type [fusion or decompression], and minimum area of the dural sac), and objective physical function (6MWD and trunk muscle strength). METHODS: Patients with LSS were consecutively included and assessed preoperatively (n=113) and 6 months postoperatively (n=78). Simple and multiple linear regression analyses were performed with 6MWD at 6 months postoperation as the dependent variable. We have study funding sources (Nagono Medical Foundation) and no study-specific conflicts of interest-associated biases. RESULTS: At 6-month follow-up, 6MWD (457.7±105.5 m) improved significantly compared with preoperative 6MWD (275.0±157.2 m; p<.01). Trunk muscle strength and pain improved significantly compared with the preoperative score (p<.01). The predictors of postoperative 6MWD were age, body weight, number of operation segments (1 or ≥2), surgery type (fusion or decompression), preoperative trunk extensor strength, and preoperative 6MWD (adjusted R2=0.65, p<.01). The proposed prediction equation was as follows: postoperative 6MWD (m)=549.5-5.3×age (years)-1.8×body weight (kg)-68.3×surgery type (0: decompression, 1: fusion)-58.6×operation segment (0: one segment, 1: ≥2 segments)+3.5×trunk extensor strength (kg)+0.2×preoperative 6MWD (m). CONCLUSIONS: Younger age, lower body weight, one level operative segment, decompression surgery, and better preoperative scores for trunk extensor strength and 6MWD predicted better scores for 6 months postoperative 6MWD. Preoperative reduction in body weight and increase of trunk extensor strength might be associated with improved postoperative 6MWD scores.
BACKGROUND CONTEXT: Few studies have investigated predictors of objective walking distance in patients with lumbar spinal stenosis (LSS). PURPOSE: This study aimed to clarify objective predictors of postoperative 6-minute walk distance (6MWD) in patients with LSS and to develop prediction equations. STUDY DESIGN: This was a prospective study. Data were analyzed by multiple linear regression analyses. PATIENT SAMPLE: Patients with LSS were enrolled. OUTCOME MEASURES: Predictors of 6MWD after surgery were evaluated, including patient characteristics (sex, age, height, and body weight), pain (visual analog scale; low back pain, lower limb pain, and lower limb numbness), surgical factors (number of operation segments [1 or ≥2], surgery type [fusion or decompression], and minimum area of the dural sac), and objective physical function (6MWD and trunk muscle strength). METHODS:Patients with LSS were consecutively included and assessed preoperatively (n=113) and 6 months postoperatively (n=78). Simple and multiple linear regression analyses were performed with 6MWD at 6 months postoperation as the dependent variable. We have study funding sources (Nagono Medical Foundation) and no study-specific conflicts of interest-associated biases. RESULTS: At 6-month follow-up, 6MWD (457.7±105.5 m) improved significantly compared with preoperative 6MWD (275.0±157.2 m; p<.01). Trunk muscle strength and pain improved significantly compared with the preoperative score (p<.01). The predictors of postoperative 6MWD were age, body weight, number of operation segments (1 or ≥2), surgery type (fusion or decompression), preoperative trunk extensor strength, and preoperative 6MWD (adjusted R2=0.65, p<.01). The proposed prediction equation was as follows: postoperative 6MWD (m)=549.5-5.3×age (years)-1.8×body weight (kg)-68.3×surgery type (0: decompression, 1: fusion)-58.6×operation segment (0: one segment, 1: ≥2 segments)+3.5×trunk extensor strength (kg)+0.2×preoperative 6MWD (m). CONCLUSIONS: Younger age, lower body weight, one level operative segment, decompression surgery, and better preoperative scores for trunk extensor strength and 6MWD predicted better scores for 6 months postoperative 6MWD. Preoperative reduction in body weight and increase of trunk extensor strength might be associated with improved postoperative 6MWD scores.
Authors: Erynne Rowe; Elizabeth Hassan; Lisa Carlesso; Janie Astephen Wilson; Douglas P Gross; Charles Fisher; Hamilton Hall; Neil Manson; Ken Thomas; Greg McIntosh; Brian Drew; Raja Rampersaud; Luciana Macedo Journal: Can J Pain Date: 2020-12-30