Department of Physical Medicine and Rehabilitation, Harvard Medical School, 125 Nashua St, Boston, MA 02114, USA.
Spine J. 2012 Feb;12(2):101-9. doi: 10.1016/j.spinee.2011.12.006. Epub 2011 Dec 29.
Walking limitations caused by neurogenic claudication (NC) are typically assessed with self-reported measures, although objective evaluation of walking using motorized treadmill test (MTT) or self-paced walking test (SPWT) has periodically appeared in the lumbar spinal stenosis (LSS) literature.
This study compared the validity and responsiveness of MTT and SPWT for assessing walking ability before and after common treatments for NC.
Prospective observational cohort study.
Fifty adults were recruited from an urban spine center if they had LSS and substantial walking limitations from NC and were scheduled to undergo surgery (20%) or conservative treatment (80%).
Walking times, distances, and speeds along with the characteristics of NC symptoms were recorded for MTT and SPWT. Self-reported measures included back and leg pain intensity assessed with 0 to 10 numeric pain scales, disability assessed with Oswestry Disability Index, walking ability assessed with estimated walking times and distances, and NC symptoms assessed with the subscales from the Spinal Stenosis Questionnaires.
Motorized treadmill test used a level track, and SPWT was conducted in a rectangular hallway. Walking speeds were self-selected, and test end points were NC, fatigue, or completion of the 30-minute test protocol. Results from MTT and SPWT were compared with each other and self-reported measures. Internal responsiveness was assessed by comparing changes in the initial results with the posttreatment results and external responsiveness by comparing walking test results that improved with those that did not improve by self-reported criteria.
Mean age of the participants was 68 years, and 58% were male. Neurogenic claudication included leg pain (88%) and buttock(s) pain (12%). Five participants could not safely perform MTT. Walking speeds were faster and distances were greater with SPWT, although the results from both tests correlated with each other and self-reported measures. Of the participants, 72% reported improvement after treatment, which was confirmed by significant mean differences in self-reported measures. Motorized treadmill test results did not demonstrate internal responsiveness to change in clinical status after treatment but SPWT results did, with increased mean walking times (6 minutes) and distances (387 m). When responsiveness was assessed against external criterion, both SPWT and MTT demonstrated substantial divergence with self-reported changes in clinical status and alternative outcome measures.
Both MTT and SPWT can quantify walking abilities in NC. As outcome tools, SPWT demonstrated better internal responsiveness than MTT, but neither test demonstrated adequate external responsiveness. Neither test should be considered as a meaningful substitution for disease-specific measures of function.
神经源性跛行（NC）引起的行走受限通常通过自我报告的测量方法进行评估，尽管使用电动跑步机测试（MTT）或自我定速步行测试（SPWT）对步行进行客观评估在腰椎狭窄症（LSS）文献中时有出现。
本研究比较了 MTT 和 SPWT 在评估 NC 常见治疗前后行走能力方面的有效性和反应性。
前瞻性观察队列研究。
如果患有 LSS 且由于 NC 导致行走受限严重，并计划接受手术（20%）或保守治疗（80%），则从城市脊柱中心招募 50 名成年人作为患者。
记录 MTT 和 SPWT 的行走时间、距离和速度，以及 NC 症状的特征。自我报告的测量包括使用 0 到 10 的数字疼痛量表评估的腰背疼痛强度、使用 Oswestry 残疾指数评估的残疾程度、使用估计的行走时间和距离评估的行走能力，以及使用 Spinal Stenosis Questionnaires 的子量表评估的 NC 症状。
电动跑步机测试使用水平轨道，SPWT 在矩形走廊进行。行走速度为自我选择，测试终点为 NC、疲劳或完成 30 分钟测试方案。将 MTT 和 SPWT 的结果与彼此以及自我报告的测量结果进行比较。内部反应性通过比较初始结果与治疗后结果来评估，外部反应性通过比较根据自我报告标准改善的步行测试结果与未改善的步行测试结果来评估。
参与者的平均年龄为 68 岁，58%为男性。神经源性跛行包括腿部疼痛（88%）和臀部疼痛（12%）。有 5 名参与者无法安全地进行 MTT。尽管两种测试结果与彼此和自我报告的测量结果相关，但 SPWT 的行走速度更快，距离更远。在治疗后，72%的参与者报告有改善，这与自我报告的测量结果的显著差异相吻合。MTT 结果不能显示治疗后临床状态变化的内部反应性，但 SPWT 结果可以，行走时间（6 分钟）和距离（387 米）均有增加。当根据外部标准评估反应性时，SPWT 和 MTT 与自我报告的临床状态变化和替代结局测量结果都存在显著差异。
MTT 和 SPWT 均可定量评估 NC 患者的行走能力。作为结局工具，SPWT 的内部反应性优于 MTT，但两者均未表现出足够的外部反应性。这两种测试都不应该被视为特定于疾病的功能测量的有意义替代方法。
