Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
Spine (Phila Pa 1976). 2024 Sep 15;49(18):1275-1280. doi: 10.1097/BRS.0000000000004984. Epub 2024 Mar 12.
Secondary analysis of a randomized controlled trial.
We investigated the ability to distinguish patients with lumbar spinal stenosis (LSS) who improved from those who did not after receiving nonsurgical treatment. We used the disorder-specific Zurich Claudication Questionnaire (ZCQ) satisfaction subscale as an external anchor and estimated the minimal clinically important differences (MCIDs) for the ZCQ symptom severity and physical function subscales.
The ZCQ satisfaction subscale effectively distinguishes surgical patients who improved from those who did not for LSS. However, its responsiveness in nonsurgical treatment has not been evaluated yet.
Eighty-four patients with LSS who received supervised physical therapy or a home exercise program were included. Patients were classified as responders or nonresponders according to the cutoff of 2.5 for the ZCQ satisfaction subscales at six weeks and one year. The external responsiveness of the ZCQ satisfaction subscale was assessed using correlational and receiver-operating characteristic (ROC) curve analyses. MCIDs for the ZCQ symptom severity and physical function subscales were estimated using anchor and distribution approaches.
Pearson correlation coefficients between the changes in outcomes and the ZCQ satisfaction subscale at six weeks and one year were 0.37 to 0.58 (symptom severity) and 0.40 to 0.45 (physical function subscales) (>0.30 is considered a good anchor). The area under the ROC curve values were 0.66 to 0.72 and 0.63 to 0.71 for the symptom severity and physical function subscales, respectively (>0.7 is considered acceptable). The MCIDs at six weeks and one year estimated from anchor-based approaches were -0.64 to -0.13 (symptom severity) and -0.39 to 0.10 (physical function), and those from the distribution-based approaches were -0.31 to -0.30 and -0.29 to -0.27, respectively.
The findings of this study suggest that the ZCQ satisfaction subscale has less ability to distinguish patients with LSS who improved in the ZCQ symptom severity and physical function subscales from those who did not after nonsurgical treatment, compared to those after surgical treatment.
随机对照试验的二次分析。
我们研究了能否在接受非手术治疗后区分腰椎管狭窄症（LSS）患者的改善情况。我们使用特定于疾病的苏黎世跛行问卷（ZCQ）满意度子量表作为外部锚定，并估计 ZCQ 症状严重程度和身体功能子量表的最小临床重要差异（MCID）。
ZCQ 满意度子量表可有效区分接受手术治疗的 LSS 患者中改善和未改善的患者。然而，其在非手术治疗中的反应性尚未得到评估。
纳入 84 例接受监督物理治疗或家庭运动计划的 LSS 患者。根据 ZCQ 满意度子量表在 6 周和 1 年时的 2.5 分界值，患者被分为应答者或非应答者。使用相关和接受者操作特性（ROC）曲线分析评估 ZCQ 满意度子量表的外部反应性。使用锚定和分布方法估计 ZCQ 症状严重程度和身体功能子量表的 MCID。
在 6 周和 1 年时，结果与 ZCQ 满意度子量表的变化之间的 Pearson 相关系数为 0.37 至 0.58（症状严重程度）和 0.40 至 0.45（身体功能子量表）（>0.30 被认为是良好的锚定）。ROC 曲线下面积值分别为 0.66 至 0.72 和 0.63 至 0.71，用于症状严重程度和身体功能子量表（>0.7 被认为是可接受的）。基于锚定的方法在 6 周和 1 年时估计的 MCID 为-0.64 至-0.13（症状严重程度）和-0.39 至 0.10（身体功能），基于分布的方法估计的 MCID 分别为-0.31 至-0.30 和-0.29 至-0.27。
与手术后相比，该研究结果表明，在非手术治疗后，ZCQ 满意度子量表在区分 LSS 患者的 ZCQ 症状严重程度和身体功能子量表的改善情况方面的能力较低。
