Walking And Moving Around - Lumbar Spinal Stenosis

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Outpatient Therapy

Bonnie Im SPT
Lumbar spinal stenosis (LSS) describes patients with symptoms related to anatomical reduction of the size of the lumbar spine.[1] They typically experience neurogenic pain and claudication when standing or walking long distances which are relieved by sitting.[1] The symptoms can radiate down the buttock, groin, anterior and posterior thigh to the feet.[1] The symptoms include pain, fatigue, heaviness, weakness and/or paresthesia.[1]

Spinal Stenosis Score:
The Swiss Spinal Stenosis Score (SSS) is an appropriate tool for this population because it specifically and comprehensively addresses the symptoms and functional deficits characteristic in patients with LSS.[2] Furthermore, the SSS addresses patient satisfaction with surgery specific for patients with LSS.[2] This questionnaire is also appropriate in an outpatient setting because it is a short, self-administered form that patients can quickly fill out.
The SSS is made up of three scales with seven questions on symptom severity, subdivided into four on pain domain and three on a neuroischemic domain, five on physical function and six on satisfaction with treatment.[2] The score increases with worsening disability.[2]
In a study by Stucki et al, they have demonstrated that the SSS is reproducible, valid, internally consistent, and responsive to clinical change.[2] In another study comparing the reliability of the SSS (Q1-12), the Shuttle Walking Test (SWT), the Oxford Claudication Score (OCS) and the Oswestry Disability Index (ODI) in LSS assessment, the condition-specific SSS was found to be the most precise.[3] Furthermore, the study found the SSS to be internally consistent and the most reproducible of the questionnaires.[3]

Swiss Spinal Stenosis Score

1. Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Practice and Research Clinical Rheumatology 2010; 24: 253-265.
2. Stucki G, Daltroy L, Liang MH, et al. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 1996; 21: 796–803.
3. Pratt RK, Fairbank JC, Virr A. The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine 2002;27(1):84-91.

The Patient-Specific Functional Scale
Mike Bokosha SPT

The Patient-Specific Functional Scale (PSFS) is a questionnaire used to quantify activity limitation and measure functional outcome for patients with any orthopedic condition1. PSFS is a patient self-reporting tool which focuses on functional limitations that are most important to the patient1. Patients rate their ability to complete an activity on a 11-point scale where 0 is unable to carry out the task and 10 is able to complete the task.The PSFS is appropriate for Lumbar Spinal Stenosis (LSS) patients who have problems with walking and moving around because it can assess functional ability to complete specific activities that are limited by LSS. In clinical practice the PSFS is useful because of it is quick and easy to administer; it takes less than 5 mins1. Furthermore the PSFS has been shown to bemore responsive to changes in patients with low back pain.

Link to The Patient-Specific Functional Scale


1. Maughan, E. F. and Lewis, J. S. (2010). "Outcome measures in chronic low back pain." European Spine Journal 19(9): 1484-1494.

Skilled Nursing Facility

Paul Glass SPT

Swiss Spinal Stenosis Questionnaire (SSS)

In order to determine what outcome tool clinicians should use to assess walking ability and overall functional mobility in patients’ with Lumbar Spinal Stenosis (LSS), it is important to have an understanding of the pathoanatomical and clinical presentation associated with this condition. According to The North American Spine Society1, “Lumbar spinal stenosis describes a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine.” These symptoms are referred to as neurogenic claudication and are provoked by walking and/or extended standing and relieved by sitting or lumbar flexion.2 Research has indicated that the most disabling factor related to LSS is walking capacity.

The Swiss Spinal Stenosis Questionnaire is a very practical and useful tool to use in the Skilled Nursing Facility setting. In less than five minutes the SSS may be administered to assess symptom severity, physical functional status and patient satisfaction from decompressive surgery. It is composed of 12 questions for all patients, and a further 6 questions for those who had treatment. The symptom severity scores range from 1-5 for each question. Both the physical function and patient satisfaction with treatment scales have scores that range from 1-4 on each question. The SSS is available through public domain and therefore is free of cost to clinicians. Stucki et al3 have shown this outcome tool to be valid, reliable, responsive, and internally consistent.

The symptom severity and physical function scale may be used to study the effectiveness of conservative treatment. The satisfaction scale could be adjusted to ask about “results of treatment” rather than results of surgery.3

The subscales of the questionnaire may be used independently. For example if you are only concerned about measuring ability to walk in patients with LSS, the 5-item Physical Function Scale is used primarily to evaluate walking capacity. These 5 items assess distance walked and activities of daily living that involve walking. The Physical Function Scale has been used to assess walking as an outcome for surgical and nonsurgical treatment in patients with LSS. North American Spine Society1 (NASS) recommended The Swiss Spinal Stenosis Questionnaire as the "gold standard" to quantify outcome in patients with spinal stenosis.3

Swiss Spinal Stenosis Questionnaire

1. Watters WC,3rd, Baisden J, Gilbert TJ, et al. Degenerative lumbar spinal stenosis: An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008;8(2):305-310. doi: 10.1016/j.spinee.2007.10.033.
2. Steurer J, Nydegger A, Held U, et al. LumbSten: The lumbar spinal stenosis outcome study. BMC Musculoskelet Disord. 2010;11:254-2474-11-254. doi: 10.1186/1471-2474-11-254; 10.1186/1471-2474-11-254.
3. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976). 1996;21(7):796-803.

Home Care Setting:

Carrie Wall SPT
Lumbar spinal stenosis (LSS) is a narrowing of the lumbar spinal canal or nerve root foramen. One of the main symptoms of LSS is neurogenic claudication, which causes the following symptoms that are aggravated by walking, standing or lumbar extension: back and/or leg numbness, pain, weakness and tingling. Because of the pain experienced with walking or standing, many of these activities are avoided, leading to significant disability and diminished quality of life. 1

Oswestry Disability Index:
The Oswestry Disability Index (ODI) is a tool that many practitioners use to assess functional status of patients with lumbar back pain, including LSS. Because individuals with LSS experience pain that limits quality of life, the Oswestry Disability Index (ODI) has been widely used to evaluate this population. 2 The ODI is an 11-question self-assessment questionnaire that asks about the severity of pain and disability in activities such as walking, sitting, standing, sleeping, sex, social life and personal care. The severity of pain is rated via a 0-5 point Likert scale, with 5 being the greatest disability. 1 The level of pain-related disability is calculated by dividing the sum of the total sores (i.e. numerator) by the total possible score(denominator), and multiplying by 100% to reach a percentage. A higher percentage indicates a greater level of disability. For each question not answered, the total possible score (denominator) is reduced by 5 (Note: many patients do not answer the question related to sex life). The questionnaire takes approximately 3.5-5 minutes to complete and approximately 1 minute to calculate the score. 3,4
The ODI has a construct validity of r = .44-.68 5, a test-retest reliability of 0.89 2.

Link to the ODI: http://www.physio-pedia.com/Oswestry_Disability_Index

1. Conway J, Tomkins CC, Haig AJ. Walking assessment in people with lumbar spinal stenosis: Capacity, performance, and self-report measures. Spine J. 2011;11(9):816-823. doi: 10.1016/j.spinee.2010.10.019; 10.1016/j.spinee.2010.10.019.
2. Pratt RK, Fairbank JC, Virr A. The reliability of the shuttle walking test, the swiss spinal stenosis questionnaire, the oxford spinal stenosis score, and the oswestry disability index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2002;27(1):84-91.
3. Fairbank JC, Pynsent PB. The oswestry disability index. Spine. 2000;25(22):2940-52; discussion 2952. http://search.proquest.com.proxymu.wrlc.org/docview/72558029?accountid=27975.
4. Mehra A, Baker D, Disney S, Pynsent PB. Oswestry disability index scoring made easy. Ann R Coll Surg Engl. 2008;90(6):497-499. doi: 10.1308/003588408X300984; 10.1308/003588408X300984.
5. Haas M, Jacobs GE, Raphael R, Petzing K. Low back pain outcome measurement assessment in chiropractic teaching clinics: Responsiveness and applicability of two functional disability questionnaires. J Manipulative Physiol Ther. 1995;18(2):79-87.

Alex Nasrinpay SPT

Swiss Spinal Stenosis Score

The Swiss spinal stenosis score (SSS) can also be used for home healthcare to assess lumbar spinal stenosis (LSS)patients. The SSS assesses back, leg, and buttock pain and function. This scale has 3 subscales which are pain, function, and treatment with scoring ranges of 1-5, 1-4, and 1-4 for each aforementioned subscale.2 This assessment was originally designed with LSS patients in mind.2 This assessment was named as a potential gold standard for assessing patients with LSS by the American Spine Society clinical guideline.1 The SSS takes into account factors that are specific to patients with LSS, such as type of pain, pain duration, and location of pain. In fact due to the specific pain and disablement patterns peculiar to LSS an assessment taking all of this into account was devised, this assessment later became the SSS.2 The SSS takes a total of about 5 to 10 minutes to administer which is shorter than the time required for some other comparable assessments used for LSS. This is useful for home health situations, additionally no equipment, training, or costs are involved with this assessment.

Swiss Spinal Stenosis Score Link

1. North American Spine Society. Evidence Based Clinical Guidelines for Multidisciplinary Spine Care: diagnosis and treatment of degenerative lumbar spinal stenosis. Burr Ridge, IL: North American Spine Society; 2007.
2. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JF. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. SPINE. 1996: 21(7): 796-803.

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