Skip to main content
SpringerLink
Log in

Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Objective functional tests like the five-repetition sit-to-stand test (5R-STS) can supplement an objective dimension to conventional patient-reported outcome measures. The reliability of unsupervised obtainment of 5R-STS performance is currently unknown.

Methods

We included patients with degenerative pathologies of the lumbar spine. Patients performed the 5R-STS during the initial clinical visit (supervised), as well as at home after instruction by a physiotherapist. At home, patients were first timed by a relative (unsupervised) and subsequently produced a video recording of themselves performing the 5R-STS for digital measurement (telesupervised). Two raters independently assessed the recordings.

Results

One hundred and twenty-one patients were recruited, of which 100 were eligible. Eighty-eight reported unsupervised results. Sixty-four returned recordings, of which 61 were ratable. Both unsupervised (r: 0.94, 95% CI 0.91–0.96, p < 0.001) and telesupervised (r: 0.90, 95% CI 0.83–0.94, p < 0.001) measurements demonstrated excellent correlation with clinical test times. Patients did not perform more slowly at home (p > 0.05). The interrater agreement for digital judgement of the telesupervised recording was excellent (ICC: 0.996, 95% CI 0.993–0.998, p < 0.001). We confirmed convergent validity with self-reported disability, back pain, and quality of life (all p < 0.05), but not with leg pain (p = 0.189).

Conclusions

Unsupervised at-home assessment using the 5R-STS is highly reliable. There does not appear to be a specific need for patients to return for a supervised 5R-STS follow-up. Rather, instructions can be provided, and the test performed and rated by a partner or family member at home. This is logistically and economically advantageous for patients, clinicians, and researchers.

Trial registry number

ClinicalTrials.gov Identifier: NCT03321357.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Falavigna A, Dozza DC, Teles AR et al (2017) Current status of worldwide use of patient-reported outcome measures (PROMs) in spine care. World Neurosurg 108:328–335. https://doi.org/10.1016/j.wneu.2017.09.002

    Article  PubMed  Google Scholar 

  2. Deyo RAM, Battie M, Beurskens AJHM et al (1998) Outcome measures for low back pain research: a proposal for standardized use. Spine 23:2003–2013

    Article  CAS  PubMed  Google Scholar 

  3. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  4. Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144

    Article  CAS  PubMed  Google Scholar 

  5. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343

    Article  CAS  PubMed  Google Scholar 

  6. Prinsen CAC, Mokkink LB, Bouter LM et al (2018) COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 27:1147–1157. https://doi.org/10.1007/s11136-018-1798-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Guzman JZ, Cutler HS, Connolly J et al (2016) Patient-reported outcome instruments in spine surgery. Spine 41:429–437. https://doi.org/10.1097/BRS.0000000000001211

    Article  PubMed  Google Scholar 

  8. Parai C, Hägg O, Lind B, Brisby H (2018) The value of patient global assessment in lumbar spine surgery: an evaluation based on more than 90,000 patients. Eur Spine J 27:554–563. https://doi.org/10.1007/s00586-017-5331-0

    Article  CAS  PubMed  Google Scholar 

  9. Algattas H, Cohen J, Agarwal N, Hamilton DK (2017) Trends in the use of patient-reported outcome instruments in neurosurgical adult thoracolumbar deformity and degenerative disease literature. J Craniovertebral Junction Spine 8:103–107. https://doi.org/10.4103/jcvjs.JCVJS_29_17

    Article  Google Scholar 

  10. Ostelo RWJG, Deyo RA, Stratford P et al (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94. https://doi.org/10.1097/BRS.0b013e31815e3a10

    Article  PubMed  Google Scholar 

  11. Gautschi OP, Corniola MV, Schaller K et al (2014) The need for an objective outcome measurement in spine surgery—the timed-up-and-go test. Spine J 14:2521–2522. https://doi.org/10.1016/j.spinee.2014.05.004

    Article  PubMed  Google Scholar 

  12. Guyatt GH, Sullivan MJ, Thompson PJ et al (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132:919–923

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Mobbs RJ, Phan K, Maharaj M, Rao PJ (2016) Physical activity measured with accelerometer and self-rated disability in lumbar spine surgery: a prospective study. Glob Spine J 6:459–464. https://doi.org/10.1055/s-0035-1565259

    Article  Google Scholar 

  14. Staartjes VE, Schröder ML (2018) The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. J Neurosurg Spine 29:380–387. https://doi.org/10.3171/2018.2.SPINE171416

    Article  PubMed  Google Scholar 

  15. Moke L, Severijns P, Schelfaut S et al (2018) Performance on balance evaluation systems test (BESTest) impacts health-related quality of life in adult spinal deformity patients. Spine 43:637. https://doi.org/10.1097/BRS.0000000000002390

    Article  PubMed  Google Scholar 

  16. Haddas R, Lieberman IH, Block A (2018) The relationship between fear-avoidance and objective biomechanical measures of function in patients with adult degenerative scoliosis. Spine 43:647. https://doi.org/10.1097/BRS.0000000000002381

    Article  PubMed  Google Scholar 

  17. Ferguson SA, Marras WS, Burr DL et al (2009) Quantification of a meaningful change in low back functional impairment. Spine 34:2060. https://doi.org/10.1097/BRS.0b013e3181b34764

    Article  PubMed  Google Scholar 

  18. Gautschi OP, Smoll NR, Corniola MV et al (2016) Validity and reliability of a measurement of objective functional impairment in lumbar degenerative disc disease: the timed up and go (TUG) test. Neurosurgery 79:270–278. https://doi.org/10.1227/NEU.0000000000001195

    Article  PubMed  Google Scholar 

  19. Regterschot GRH, Zhang W, Baldus H et al (2014) Test–retest reliability of sensor-based sit-to-stand measures in young and older adults. Gait Posture 40:220–224. https://doi.org/10.1016/j.gaitpost.2014.03.193

    Article  PubMed  Google Scholar 

  20. Ejupi A, Brodie M, Gschwind YJ et al (2015) Kinect-based five-times-sit-to-stand test for clinical and in-home assessment of fall risk in older people. Gerontology 62:118–124. https://doi.org/10.1159/000381804

    Article  PubMed  Google Scholar 

  21. Joswig H, Stienen MN, Smoll NR et al (2017) Patients’ preference of the timed up and go test or patient-reported outcome measures before and after surgery for lumbar degenerative disk disease. World Neurosurg 99:26–30. https://doi.org/10.1016/j.wneu.2016.11.039

    Article  PubMed  Google Scholar 

  22. Jones SE, Kon SSC, Canavan JL et al (2013) The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax 68:1015–1020. https://doi.org/10.1136/thoraxjnl-2013-203576

    Article  PubMed  Google Scholar 

  23. Duncan RP, Leddy AL, Earhart GM (2011) Five times sit to stand test performance in Parkinson disease. Arch Phys Med Rehabil 92:1431–1436. https://doi.org/10.1016/j.apmr.2011.04.008

    Article  PubMed  PubMed Central  Google Scholar 

  24. Simmonds MJ, Olson SL, Jones S et al (1998) Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 23:2412–2421

    Article  CAS  PubMed  Google Scholar 

  25. Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745. https://doi.org/10.1016/j.jclinepi.2010.02.006

    Article  PubMed  Google Scholar 

  26. Von Elm E, Altman DG, Egger M et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806–808. https://doi.org/10.1136/bmj.39335.541782.AD

    Article  Google Scholar 

  27. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  28. Core Team R (2018) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  29. Stienen MN, Smoll NR, Joswig H et al (2017) Validation of the baseline severity stratification of objective functional impairment in lumbar degenerative disc disease. J Neurosurg Spine. https://doi.org/10.3171/2016.11.SPINE16683

    Article  PubMed  Google Scholar 

  30. Shum GLK, Crosbie J, Lee RYW (2007) Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit. Spine 32:E211–E219. https://doi.org/10.1097/01.brs.0000259204.05598.10

    Article  PubMed  Google Scholar 

  31. Shum GLK, Crosbie J, Lee RYW (2005) Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit. Spine 30:1998–2004

    Article  PubMed  Google Scholar 

  32. Gautschi OP, Joswig H, Corniola MV et al (2016) Pre- and postoperative correlation of patient-reported outcome measures with standardized timed up and go (TUG) test results in lumbar degenerative disc disease. Acta Neurochir (Wien) 158:1875–1881. https://doi.org/10.1007/s00701-016-2899-9

    Article  Google Scholar 

  33. Gautschi OP, Stienen MN, Corniola MV et al (2016) Assessment of the minimum clinically important difference in the timed up and go test after surgery for lumbar degenerative disc disease. Neurosurgery. https://doi.org/10.1227/NEU.0000000000001320

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Marlies P. de Wispelaere, MSc, for her efforts in clinical informatics.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Bergman Clinics Amsterdam, Rijksweg 69, 1411 GE, Naarden, The Netherlands

    Victor E. Staartjes, Femke Beusekamp & Marc L. Schröder

  2. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Victor E. Staartjes

  3. Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands

    Victor E. Staartjes

Authors
  1. Victor E. Staartjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Femke Beusekamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc L. Schröder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor E. Staartjes.

Ethics declarations

Conflict of interest

The authors declare that the article and its content were composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 9491 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Staartjes, V.E., Beusekamp, F. & Schröder, M.L. Can objective functional impairment in lumbar degenerative disease be reliably assessed at home using the five-repetition sit-to-stand test? A prospective study. Eur Spine J 28, 665–673 (2019). https://doi.org/10.1007/s00586-019-05897-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-05897-3

Keywords

Search

Navigation