Evaluating the walking perimeter in patients with spinal stenosis. A comparison between clinical interview and standardized walk test at comfortable speed

Abstract

Gait dysfunctions are common in patients with spinal stenosis. In fact, these patients may present intermittent radicular claudication, which result in a decreased walking perimeter. Thus in these patients, the walking perimeter reveals the impact of the disease on quality of life and accounts for the therapeutic decision, notably surgical. Usually, in clinical practice, walking perimeter is assessed by a medical interview. Some authors highlight the error of subjective verbal quantification. Therefore, the main objective was to quantify the difference between the walking perimeter determined using either a medical interview or a walk test at comfortable speed. The secondary objective was to correlate functional tests with walking perimeter. In this monocentric study, each patient was asked to verbally estimate his walking perimeter during a preoperative consultation. Walking perimeter was then evaluated using a walking test at comfortable speed in which the patient walked a maximal distance. Functional muscular tests (Sorensen and Shirado) were also performed. Twenty patients have been included (age: 68.9 ± 8.6 years, BMI: 28.7 ± 3.5 kg.m −2 ). During medical interview, patients reported a significantly lower average walking perimeter than during walk test (317 ± 178 m and 442 ± 99 m respectively; P < 0.05). Among functional tests (Shirado: 84.2 ± 51.0 s; Sorensen: 75.4 ± 39.1 s), only Shirado test was correlated with walking perimeter assessed by walk test (Shirado: r = 0.48; P = 0.03) whereas no correlation was found for walking perimeter assessed by medical interview. Our study confirms previous results showing that subjective walking perimeter estimation is not a valid outcome. Patients with spinal stenosis underestimated their actual walking perimeter during the preoperative consultation. Thus comfortable walk test should be used in clinical practice to quantify the walking perimeter in patients with spinal stenosis, and more broadly, because it seems correlated to functional capacities of patients. The underlying reasons explaining the difference observed need to be explored.