Abstract
Study design
Prospective, non-blinded, non-randomization.
Purpose
Pain scales are commonly used to assess the condition of spine patients, although the degree of correlation between different pain scores, and between the scores and the patients’ functional status is, at best, variable. Pain usually limits physical activities, but there is a lack of a widely accepted tool for investigating pain-related physical impairment in everyday routine work. The purpose of this study was to evaluate and correlate the visual analog scale (VAS) and the “timed up and go” (TUG) test in patients after lumbar spondylodesis.
Methods
Thirty-eight patients with degenerative lumbar disease who were treated with monosegmental or bisegmental spondylodesis were included on a consecutive and prospective basis. The VAS and TUG were assessed preoperatively and during the first 12 weeks postoperatively. Special attention was paid to the early follow-up after surgical intervention. Correlations between the two tests were assessed.
Results
The VAS showed gradual reduction after surgery, reaching statistical significance on the sixth postoperative day, with significant changes over time from the first to third, third to sixth postoperative days and from the sixth postoperative day to 2 weeks after surgery. In contrast, the TUG demonstrated a significant deterioration in function on the first and third postoperative days, returning to baseline levels thereafter (at postoperative days 6 and 14). Significant improvement in function in comparison with the preoperative status was established after 4 weeks and continued until the last follow-up examination. The TUG showed significant differences between all visits along the timeline. A correlation between the two tests was only observed on the first day after surgery.
Conclusion
In summary, the TUG appeared to be significantly more sensitive for describing the course after spine surgery. The TUG represents an appropriate performance-based functional test that is not time-consuming. Assessment of both pain and functionality is, therefore, needed to evaluate patients adequately.
Similar content being viewed by others
References
Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery—the case for restraint. N Engl J Med 350:722–726. doi:10.1056/NEJMsb031771
Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23:2003–2013
Zanoli G (2005) Outcome assessment in lumbar spine surgery. Acta Orthop Suppl 76:5–47
Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. J Pain Symptom Manage 41:1073–1093. doi:10.1016/j.jpainsymman.2010.08.016
Podsiadlo D, Richardson S (1991) The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148
De Buyser SL, Petrovic M, Taes YE, Toye KR, Kaufman JM, Goemaere S (2013) Physical function measurements predict mortality in ambulatory older men. Eur J Clin Invest 43:379–386. doi:10.1111/eci.12056
Mathias S, Nayak US, Isaacs B (1986) Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil 67:387–389
Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), mcgill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 63(Suppl 11):S240–S252. doi:10.1002/acr.20543
Dijkers M (2010) Comparing quantification of pain severity by verbal rating and numeric rating scales. J Spinal Cord Med 33:232–242
Jäckel WH, Beyer WF, Droste U, Engel J-, Genth E, Kohlmann T, Kriegel W, Mau W, Pott H-, Rehberg W, Sangha O, Schmidt K, Wassenberg S, Zink A (2001) Outcome-Messung bei muskuloskelettalen krankheiten: vorschlag für ein core-set von instrumenten zum einsatz in der rehabilitation. Zeitschrift Für Rheumatologie 60:342–351. doi:10.1007/s003930170034
Ntoukas V, Müller A (2010) Minimally invasive approach versus traditional open approach for one level posterior lumbar interbody fusion. Minim Invasive Neurosurg 53:21–24. doi:10.1055/s-0030-1247560
Park Y, Ha JW (2007) Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 32:537–543. doi:10.1097/01.brs.0000256473.49791.f4
Hafsteinsdóttir TB, Rensink M, Schuurmans M (2014) Clinimetric properties of the timed up and go test for patients with stroke: a systematic review. Top Stroke Rehabil 21:197–210. doi:10.1310/tsr2103-197
Barry E, Galvin R, Keogh C, Horgan F, Fahey T (2014) Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 14:14. doi:10.1186/1471-2318-14-14
Nicolini-Panisson RD, Donadio MV (2013) Timed “up & go” test in children and adolescents. Rev Paul Pediatr 31:377–383. doi:10.1590/S0103-05822013000300016
Dobson F, Hinman RS, Hall M, Terwee CB, Roos EM, Bennell KL (2012) Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review. Osteoarthr Cartil 20:1548–1562. doi:10.1016/j.joca.2012.08.015
Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C (2011) Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging 15:933–938
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 (Phila Pa 1976) 8:141–144
Roland M, Morris R (1983) A study of the natural history of low-back pain. Part II: Development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 8:145–150
Mahoney FI, Barthel DW (1965) Functional evaluation: the barthel index. Md State Med J 14:61–65
Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine (Phila Pa 1976) 25:2940–2952 (discussion 2952)
Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Gautschi OP, Corniola MV, Schaller K, Smoll NR, Stienen MN (2014) Assessing the outcomes of spine surgery using global positioning systems. Spine (Phila Pa 1976) 14:2521–2522. doi:10.1097/BRS.0b013e3181da3737
Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther 80:896–903
Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH (2011) A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther 41:319–327. doi:10.2519/jospt.2011.3515
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33:90–94. doi:10.1097/BRS.0b013e31815e3a10
Acknowledgments
None of the authors has any conflicts of interest in connection with the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
Date of approval: April 13th, 2012; ethical approval ID: UN4624; session number 310/4.6.
Additional information
S. Hartmann and A. A. Hegewald contributed equally to this work.
Rights and permissions
About this article
Cite this article
Hartmann, S., Hegewald, A.A., Tschugg, A. et al. Analysis of a performance-based functional test in comparison with the visual analog scale for postoperative outcome assessment after lumbar spondylodesis. Eur Spine J 25, 1620–1626 (2016). https://doi.org/10.1007/s00586-015-4350-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4350-y