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

  • Victor E. StaartjesEmail author
  • Anita M. Klukowska
  • Marc L. Schröder
Original Article


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.

Trial registration NCT03321357 & NCT03303300


Objective 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.

Ethical approval

The prospective studies ( 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.

Informed consent

Written informed consent was obtained from all participants.

Supplementary material

Supplementary Methods 1 1 R Code for the statistical analysis figure rendering. The code was executed in R Version 3.5.2 (The R Foundation for Statistical Computing, Vienna, Austria) on a machine running Windows 10 (Microsoft Corp., Redmond, WA, USA). The raw data will be made available by the authors on request. (R 10 kb)
10143_2019_1168_MOESM2_ESM.docx (16 kb)
ESM 2 (DOCX 16 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryBergman Clinics, NaardenNaardenThe Netherlands
  2. 2.Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement SciencesAmsterdamThe Netherlands
  3. 3.Department of Neurosurgery, Clinical Neuroscience Center, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  4. 4.School of MedicineUniversity of NottinghamNottinghamUK

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