Association of maximum back and leg pain severity with objective functional impairment as assessed by five-repetition sit-to-stand testing: analysis of two prospective studies
The five-repetition sit-to-stand (5R-STS) test was designed to capture objective functional impairment (OFI), and provides a new adjunctive dimension in patient assessment. Its interpretability and confounders remain poorly understood. We quantify the association among maximum patient-reported back (MBP) or leg pain (MLP) and OFI as measured by the 5R-STS using data from two prospective studies. Patients performed the 5R-STS test and completed visual analogue scales (VAS) for back and leg pain severity. Maximum pain severity was defined as VAS scores of 9 or 10. The association of MBP and MLP with 5R-STS test times as well as with the presence of OFI (> 10.5 s) and severe OFI (> 22.0 s) as determined by the 5R-STS baseline severity stratification was quantified by use of crude and adjusted regression models. A total of 258 patients were included. MBP and MLP were reported by 27 (10.5%) and 76 (29.5%) patients, respectively. Rates of OFI differed among patients with (92.6%) and without (55.0%) MBP (p < 0.001), while presence of MLP did not influence OFI (61.8% vs. 57.7%, p = 0.632). Similarly, severe OFI was more common among patients with MBP (33.3% vs. 9.1%, p < 0.001), but not among patients with MLP (17.1% vs. 9.3%, p = 0.119). In the adjusted logistic analysis, the influence of MBP on OFI persisted (odds ratio [OR] 10.08, confidence interval [CI] 2.73–65.74, p = 0.003), while MLP demonstrated no association (OR 0.91, CI 0.49–1.72, p = 0.780). These associations were consistent with findings pertaining to raw 5R-STS test times and in discectomy patients alone. There is a strong association of maximum back pain severity on VAS with the degree of OFI determined by 5R-STS testing. Radiculopathy with maximally strong back pain, however, does not seem to relevantly influence 5R-STS performance.
ClinicalTrials.gov: NCT03321357 & NCT03303300
KeywordsObjective functional testing Functional impairment Degenerative disc disease Lumbar spinal stenosis Lumbar disc herniation Pain
The authors are grateful to all participating patients, and to Marlies P. de Wispelaere, MSc for her efforts in clinical informatics.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The prospective studies (ClinicalTrials.gov Identifiers: NCT03321357 & NCT03303300) were approved by the local institutional review board (Medical Research Ethics Committees United, Registration Number: W17.107 and W17.134), and were conducted according to the Declaration of Helsinki.
Written informed consent was obtained from all participants.
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