Stienen Martin N, Smoll Nicolas R, Joswig Holger, Corniola Marco V, Schaller Karl, Hildebrandt Gerhard, Gautschi Oliver P
Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva.
School of Medicine and Public Health, University of Newcastle, Australia.
J Neurosurg Spine. 2017 May;26(5):598-604. doi: 10.3171/2016.11.SPINE16683. Epub 2017 Mar 3.
OBJECTIVE The Timed Up and Go (TUG) test is a simple, objective, and standardized method to measure objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). The objective of the current work was to validate the OFI baseline severity stratification (BSS; with levels of "none," "mild," "moderate," and "severe"). METHODS Data were collected in a prospective IRB-approved 2-center study. Patients were assessed with a comprehensive panel of scales for measuring pain (visual analog scale [VAS] for back and leg pain), functional impairment (Roland-Morris Disability Index [RMDI] and Oswestry Disability Index [ODI]), and health-related quality of life (HRQOL; EQ-5D and SF-12). OFI BSS was determined using age- and sex-adjusted cutoff values. RESULTS A total of 375 consecutive patients scheduled for lumbar spine surgery were included. Each 1-step increase on the OFI BSS corresponded to an increase of 0.53 in the back pain VAS score, 0.69 in the leg pain VAS score, 1.81 points in the RMDI, and 5.93 points in the ODI, as well as to a decrease in HRQOL of -0.073 in the EQ-5D, -1.99 in the SF-12 physical component summary (PCS), and -1.62 in the SF-12 mental component summary (MCS; all p < 0.001). Patients with mild, moderate, and severe OFI had increased leg pain by 0.90 (p = 0.044), 1.54 (p < 0.001), and 1.94 (p < 0.001); increased ODI by 7.99 (p = 0.004), 12.64 (p < 0.001), and 17.13 (p < 0.001); and decreased SF-12 PCS by -2.57 (p = 0.049), -3.63 (p = 0.003), and -6.23 (p < 0.001), respectively. CONCLUSIONS The OFI BSS is a valid measure of functional impairment for use in daily clinical practice. The presence of OFI indicates the presence of significant functional impairment on subjective outcome measures.
目的 “起立行走测试”（TUG 测试）是一种简单、客观且标准化的方法，用于测量腰椎退变性椎间盘疾病（DDD）患者的客观功能损害（OFI）。本研究的目的是验证 OFI 基线严重程度分层（BSS；分为“无”“轻度”“中度”和“重度”）。方法 数据收集于一项经机构审查委员会（IRB）批准的前瞻性双中心研究。使用一系列综合量表对患者进行评估，包括测量疼痛（背部和腿部疼痛的视觉模拟量表 [VAS]）、功能损害（罗兰 - 莫里斯残疾指数 [RMDI] 和奥斯维斯特残疾指数 [ODI]）以及健康相关生活质量（HRQOL；EQ - 5D 和 SF - 12）。OFI BSS 使用年龄和性别调整后的临界值来确定。结果 总共纳入了 375 例计划进行腰椎手术的连续患者。OFI BSS 每增加 1 级，对应背部疼痛 VAS 评分增加 0.53、腿部疼痛 VAS 评分增加 0.69、RMDI 增加 1.81 分、ODI 增加 5.93 分，同时 EQ - 5D 的 HRQOL 降低 -0.073、SF - 12 身体成分总结（PCS）降低 -1.99、SF - 12 心理成分总结（MCS）降低 -1.62（所有 p < 0.001）。轻度、中度和重度 OFI 患者的腿部疼痛分别增加 0.90（p = 0.044）、1.54（p < 0.001）和 1.94（p < 0.001）；ODI 分别增加 7.99（p = 0.004）、12.64（p < 0.001）和 17.13（p < 0.00）；SF - 12 PCS 分别降低 -2.57（p = 0.049）、-3.63（p = 0.003）和 -6.23（p < 0.001）。结论 OFI BSS 是一种可用于日常临床实践的有效功能损害测量方法。OFI 的存在表明在主观结局测量中存在显著的功能损害。
