External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection

Background: The 6-minute walking test (6WT) has previously shown to be reliable and valid outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). A role of 6WT in conservatively treated patients undergoing epidural steroid injection (ESI) remains unclear. Methods: Abo...

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Main Authors: Michal Ziga, MD, Martin N. Stienen, MD/FEBNS, Anna Maria Zeitlberger, MD, Stefanos Voglis, MD, Luca Regli, MD, Oliver Bozinov, MD, Nicolai Maldaner, MD
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:North American Spine Society Journal
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666548424002543
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author Michal Ziga, MD
Martin N. Stienen, MD/FEBNS
Anna Maria Zeitlberger, MD
Stefanos Voglis, MD
Luca Regli, MD
Oliver Bozinov, MD
Nicolai Maldaner, MD
author_facet Michal Ziga, MD
Martin N. Stienen, MD/FEBNS
Anna Maria Zeitlberger, MD
Stefanos Voglis, MD
Luca Regli, MD
Oliver Bozinov, MD
Nicolai Maldaner, MD
author_sort Michal Ziga, MD
collection DOAJ
description Background: The 6-minute walking test (6WT) has previously shown to be reliable and valid outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). A role of 6WT in conservatively treated patients undergoing epidural steroid injection (ESI) remains unclear. Methods: About 50 patients with DLD, scheduled for ESI were assessed by the smartphone-based 6WT and common paper-based patient-reported outcome measures (PROMs), including the Core Outcome Measures Index [COMI] back, Oswestry Disability Index (ODI) and Short Form Survey (SF-12). Pearson correlation coefficient (PCC) was used to define the relationship between 6WT and PROMs. Reliability of the 6WT was determined by intraclass correlation coefficient (ICC). Age- and sex-adjusted objective functional impairment (OFI) z-scores were calculated for each patient. Results: A total of 50 patients (mean age 52 years, SD 13; 25% female), including 35 patients (70%) with lumbar disc herniation and 15 patients (30%) with lumbar spinal stenosis were included. The mean 6-minute walking distance (6WD) was 454.1 m (SD 89.1); the age- and sex-adjusted mean OFI z-score was −2.1 (SD 4.0). A total of 17 (34%) patients had mild, 8 (16%) moderate, and 4 (8%) severe OFI, while 21 (42%) had 6WT results within the normal population range (no OFI). The PCCs between the 6WD and VAS back pain were r=−0.30, ODI r=−0.43, COMI back r=−0.36, and PCS-12 r=0.51 (all p<.05). The ICC of the 6WT was β=0.92. Conclusions: This external validation in a patient cohort with DLD, which was managed conservatively, confirms the reliability and content validity of the 6WT with similar PCCs with PROMs compared to the original surgical cohort. The results confirm the 6WT as a valid and useful tool for assessing OFI in patients with DLD and a broad range of functional restrictions in an outpatient setting.
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spelling doaj-art-6f9dafa2ba834817850b09bff5dab9982024-12-18T08:53:12ZengElsevierNorth American Spine Society Journal2666-54842024-12-0120100561External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injectionMichal Ziga, MD0Martin N. Stienen, MD/FEBNS1Anna Maria Zeitlberger, MD2Stefanos Voglis, MD3Luca Regli, MD4Oliver Bozinov, MD5Nicolai Maldaner, MD6Department of Neurosurgery, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, Switzerland; First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Spine Center of Eastern Switzerland, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery and Spine Surgery, Luzerner Kantonsspital and University of Lucerne, Lucerne, SwitzerlandDepartment of Neurosurgery, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, Switzerland; Spine Center of Eastern Switzerland, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, SwitzerlandDepartment of Neurosurgery, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, Switzerland; Spine Center of Eastern Switzerland, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, SwitzerlandDepartment of Neurosurgery, University Hospital Zurich &amp; Clinical Neuroscience Centre, University of Zurich, Zurich, SwitzerlandDepartment of Neurosurgery, University Hospital Zurich &amp; Clinical Neuroscience Centre, University of Zurich, Zurich, SwitzerlandDepartment of Neurosurgery, Kantonsspital St. Gallen &amp; Medical School of St.Gallen, St. Gallen, Switzerland; Department of Neurosurgery, University Hospital Zurich &amp; Clinical Neuroscience Centre, University of Zurich, Zurich, SwitzerlandDepartment of Neurosurgery, University Hospital Zurich &amp; Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland; Corresponding author. Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland.Background: The 6-minute walking test (6WT) has previously shown to be reliable and valid outcome measure in patients undergoing surgery for degenerative lumbar disorders (DLD). A role of 6WT in conservatively treated patients undergoing epidural steroid injection (ESI) remains unclear. Methods: About 50 patients with DLD, scheduled for ESI were assessed by the smartphone-based 6WT and common paper-based patient-reported outcome measures (PROMs), including the Core Outcome Measures Index [COMI] back, Oswestry Disability Index (ODI) and Short Form Survey (SF-12). Pearson correlation coefficient (PCC) was used to define the relationship between 6WT and PROMs. Reliability of the 6WT was determined by intraclass correlation coefficient (ICC). Age- and sex-adjusted objective functional impairment (OFI) z-scores were calculated for each patient. Results: A total of 50 patients (mean age 52 years, SD 13; 25% female), including 35 patients (70%) with lumbar disc herniation and 15 patients (30%) with lumbar spinal stenosis were included. The mean 6-minute walking distance (6WD) was 454.1 m (SD 89.1); the age- and sex-adjusted mean OFI z-score was −2.1 (SD 4.0). A total of 17 (34%) patients had mild, 8 (16%) moderate, and 4 (8%) severe OFI, while 21 (42%) had 6WT results within the normal population range (no OFI). The PCCs between the 6WD and VAS back pain were r=−0.30, ODI r=−0.43, COMI back r=−0.36, and PCS-12 r=0.51 (all p<.05). The ICC of the 6WT was β=0.92. Conclusions: This external validation in a patient cohort with DLD, which was managed conservatively, confirms the reliability and content validity of the 6WT with similar PCCs with PROMs compared to the original surgical cohort. The results confirm the 6WT as a valid and useful tool for assessing OFI in patients with DLD and a broad range of functional restrictions in an outpatient setting.http://www.sciencedirect.com/science/article/pii/S26665484240025436-minute walking test6WTExternal validityFunctional self-assessmentObjective functional impairment
spellingShingle Michal Ziga, MD
Martin N. Stienen, MD/FEBNS
Anna Maria Zeitlberger, MD
Stefanos Voglis, MD
Luca Regli, MD
Oliver Bozinov, MD
Nicolai Maldaner, MD
External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
North American Spine Society Journal
6-minute walking test
6WT
External validity
Functional self-assessment
Objective functional impairment
title External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
title_full External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
title_fullStr External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
title_full_unstemmed External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
title_short External validation of the smartphone-based 6-minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
title_sort external validation of the smartphone based 6 minute walking test in patients with degenerative lumbar disorders undergoing epidural steroid injection
topic 6-minute walking test
6WT
External validity
Functional self-assessment
Objective functional impairment
url http://www.sciencedirect.com/science/article/pii/S2666548424002543
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