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European Spine Journal
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Open Access 13-08-2024 | Spinal Stenosis | Original Article

Responsiveness of the Oswestry Disability Index and Zurich Claudication Questionnaire in patients with lumbar spinal stenosis: evaluation of surgically treated patients from the NORDSTEN study

Authors: Kari Indrekvam, Tor Åge Myklebust, Ivar Magne Austevoll, Erland Hermansen, Hasan Banitalebi, Ingrid Fjeldheim Bånerud, Clemens Weber, Helena Brisby, Jens Ivar Brox, Christian Hellum, Kjersti Storheim

Published in: European Spine Journal | Issue 11/2024

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Abstract

Purpose

To evaluate the responsiveness of the original low back pain specific Oswestry Disability Index (ODI) and the spinal stenosis specific Zürich Claudication Questionnaire (ZCQ), and to investigate cut-off values for clinical “success” for ODI and ZCQ in surgically treated patients with lumbar spinal stenosis (LSS).

Methods

We included 601 LSS patients (218 with, 383 without degenerative spondylolisthesis) from the NORDSTEN trials. Outcome measures included ODI and ZCQ (symptom severity and physical function scales) with three alternative response parameters: scores at follow-up, absolute and relative changes from baseline to two-year follow-up. Effect size and standardised response mean evaluated internal responsiveness. External responsiveness was assessed by the Spearman rank correlation between patient-reported global perceived effect scale (GPE) and ODI and ZCQ, and receiver operating characteristics (ROC). We evaluated which cut-off values could maximise the percentage of correctly classified patients according to the GPE-anchor “completely recovered” / “much improved” for each parameter.

Results

Internal and external responsiveness were high for all three indices with effect sizes, standardized response means, ROC and corresponding area under the curve > 0.8. Correlations with GPE responses were moderate (> 0.50) for absolute change and strong (> 0.67) for relative change and follow-up scores. The 30% ODI relative change cut-off correctly classified 81% of patients to “success”, within a range of accurate cut-offs according to the GPE-anchor.

Conclusion

ODI and ZCQ demonstrate comparable responsiveness in evaluating outcomes for surgically treated LSS patients. The 30% ODI threshold was consistent with treatment “success” in NORDSTEN trials.

Trial registration

ClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.
Appendix
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Metadata
Title
Responsiveness of the Oswestry Disability Index and Zurich Claudication Questionnaire in patients with lumbar spinal stenosis: evaluation of surgically treated patients from the NORDSTEN study
Authors
Kari Indrekvam
Tor Åge Myklebust
Ivar Magne Austevoll
Erland Hermansen
Hasan Banitalebi
Ingrid Fjeldheim Bånerud
Clemens Weber
Helena Brisby
Jens Ivar Brox
Christian Hellum
Kjersti Storheim
Publication date
13-08-2024
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 11/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-024-08440-1

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