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Relationship Between Ambulatory Performance and Self-Rated Disability in Patients With Lumbar Spinal Stenosis

Pryce, Rob, MSc*; Johnson, Michael, MD; Goytan, Michael, MD; Passmore, Steven, DC*; Berrington, Neil, MD; Kriellaars, Dean, PhD*

doi: 10.1097/BRS.0b013e31824a8314
Health Services Research

Study Design. A cross-sectional study.

Objective. To identify the relationship between performance measures derived from accelerometry and subjective reports of pain, disability, and health in patients with lumbar spinal stenosis (LSS).

Summary of Background Data. Accelerometers have emerged as a measure of performance, providing the ability to characterize the pattern and magnitude of real-life activity, and sedentarism. Pain and loss of function, particularly ambulation, are common in LSS. The extent to which pain, perceived disability, and self-rated health relate to performance in patients with LSS is not well known.

Methods. Data regarding self-reported pain, disability (Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Disabilities of the Arm, Shoulder, and Hand), and health (36-Item Short Form Health Survey [SF-36]) were collected from patients with LSS (n = 33). Physical activity, ambulation, and inactivity performance measures were derived from 7-day accelerometer records. Correlation and stepwise regression were used.

Results. The physical function subscale of the SF-36, a non–pathology-specific outcome, had the best overall correlation to physical activity and ambulation (average r = 0.53) compared with pain (average r = 0.32) and disability (average r = −0.45) outcomes. Stepwise regression models for performance were predominantly single-variable models (4 of 8 models); pain was not selected as a predictor. A second non–pathology-specific outcome, the Disabilities of Arm Shoulder and Hand, improved the prediction of performance in 5 of 8 models.

Conclusion. Subjective measures of pain and disability had limited ability to account for real-life performance in patients with LSS. Future research is required to identify determinants of performance in patients with LSS because barriers to activity may not be disease-specific.

The relationship of pain and disability with performance was evaluated in patients with lumbar spinal stenosis, using accelerometry. Domain-specific measures provided improved explanatory ability above disease-specific disability and pain assessments for ambulatory behavior. Outcome assessments should include performance measures, and interventional approaches need to address non-diseasespecific barriers.

*School of Medical Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada

Sections of Orthopedic Surgery

Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.

Address correspondence and reprint requests to Rob Pryce, MSc, School of Medical Rehabilitation, University of Manitoba, AD401-820 Sherbrook St., Winnipeg, Manitoba R3A 1R9, Canada; E-mail:

Acknowledgment date: April 5, 2011. First revision date: July 14, 2011. Second revision date: December 1, 2011. Acceptance date: January 9, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.