Stride length of elderly patients with lumbar spinal stenosis: Multi-center study using the Two-Step test

Effects of Nurse-Led Fall Prevention Programs for Older Adults: A Systematic Review

Falls among older adults are preventable events and fall prevention programs led by nursing staff are promising and viable programs for preventing falls. This systematic review aimed to gain insight into the effects of nurse-led fall prevention programs for older adults. The Preferred Reporting Items for Systemic Reviews and Meta-Analysis was used as a guideline in reporting this literature search conducted through CINAHL, MEDLINE, Eric, Science Direct, and Google Scholar databases. The Johns Hopkins Nursing Evidence-Based Practice was used to determine the level of evidence and quality rating of the articles, while data extraction was done by a matrix review method. The review included six randomized controlled trials, two non-randomized controlled trials, and three quasi-experimental designs. Six studies directed their education component of the intervention on the nursing staff, while three focused on the older participants. Nurses' roles were patient assessment, patient education, administration of exercise programs, and follow-up post interventions. Fall rates and fall incidents were reduced in five studies, while three studies changed patients' behavior. Fall prevention programs with education components specific for older adults and nursing staff resulted in positive outcomes. Nursing staff make a significant contribution to improving patients' outcomes, and a fall prevention program that focuses on reducing injurious fall rates and enhancing participants' behavior could maximize its effects.

Analysing Gait Patterns in Degenerative Lumbar Spine Disease Using Inertial Wearable Sensors: An Observational Study

OBJECTIVE

Using a chest-based inertial wearable sensor, we examined the quantitative gait patterns associated with lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), and chronic mechanical low back pain (CMLBP). 'Pathological gait signatures' were reported as statistically significant group difference (%) from the 'normative' gait values of an age-matched control population.

METHODS

A sample of patients presenting to the Prince of Wales Private Hospital (Sydney, Australia) with primary diagnoses of LDH, LSS, or CMLBP were recruited. Spatial, temporal, asymmetry, and variability metrics were compared with age-matched (±2 years) control participants recruited from the community. Participants were fitted at the sternal angle with an inertial measurement unit, MetaMotionC, and walked unobserved (at a self-selected pace) for 120 m along an obstacle-free, carpeted hospital corridor.

RESULTS

LDH, CMLBP, and LSS groups had unique pathological signatures of gait impairment. The LDH group (n = 33) had marked asymmetry in terms of step length, step time, stance, and single-support asymmetry. The LDH group also involved gait variability with increased step length variation. However, distinguishing the CMLBP group (n = 33) was gait variability in terms increased single-support time variation. The gait of participants with LSS (n = 22) was both asymmetric and variable in step length.

CONCLUSIONS

Wearable sensor-based accelerometry was found to be capable of detecting the gait abnormalities present in patients with LDH, LSS, and CMLBP, when compared to age-matched controls. Objective and quantitative patterns of gait deterioration uniquely varied between these subtypes of lumbar spine disease. With further testing and validation, gait signatures may aid clinical identification of gait-altering pathologies.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Quantitative Gait Analysis of Patients with Severe Symptomatic Spinal Stenosis Utilizing the Gait Profile Score: An Observational Clinical Study

Lumbar spine stenosis (LSS) typically manifests with neurogenic claudication, altering patients’ gait. The use of optoelectronic systems has allowed clinicians to perform 3D quantitative gait analysis to quantify and understand these alterations. Although several authors have presented analysis of spatiotemporal gait parameters, data concerning kinematic parameters is lacking. Fifteen patients with LSS were matched with 15 healthy controls. Quantitative gait analysis utilizing optoelectronic techniques was performed for each pair of subjects in a specialized laboratory. Statistical comparison of patients and controls was performed to determine differences in spatiotemporal parameters and the Gait Profile Score (GPS). Statistically significant differences were found between patient and control groups for all spatiotemporal parameters. Patients had significantly different overall GPS (p = 0.004) and had limited internal/external pelvic rotation (p < 0.001) and cranial/caudal movement (p = 0.034), limited hip extension (p = 0.012) and abduction/adduction (p = 0.012) and limited ankle plantar flexion (p < 0.001). In conclusion, patients with LSS have significantly altered gait patterns in three regions (pelvis, hip and ankle) compared to healthy controls. Analysis of kinematic graphs has given insight into gait pathophysiology of patients with LSS and the use of GPS will allow us to quantify surgical results in the future.

Classification of Older and Fall-Experienced Subjects by Postural Sway Data using Mass Spring Damper Model

The quiet standing test is used to detect diseases of the postural control system. The descriptive statistics of the center of pressure (COP) of older people during the test tend to be larger than those of healthy young people, but they cannot indicate structural problems in postural control. COP trajectories can be mathematically modeled with structural parameters such as viscosity, stiffness, and stochastic terms; however, the classification accuracy of older and fall-experienced people using such parameters has not been sufficiently verified. In this study, six structural parameters of a mass-spring-damper (MSD) model were estimated using two datasets, in which a total of 212 subjects performed quiet standing tests under four conditions. The estimated parameters were used for classification with a random forest algorithm to examine the differences in classification accuracy compared to seven conventional descriptive statistics methods. For the classification of older subjects, the classification accuracy of the MSD parameter method was the highest in foam condition, with positive likelihood ratios approximately 8.0. For the classification of fall-experienced subjects, the positive likelihood ratio of the MSD parameter method was 5.0, which is better than conventional descriptive statistics. Various MSD parameters revealed that aging and changing the floor surface and visual conditions cause oscillations in the COP behavior. While the MSD parameters were confirmed to help classify older subjects more accurately than the conventional descriptive statistics, there was room for further improvement in the classification accuracy of fall-experienced subjects.

The association between pain, balance, fall, and disability in patients with lumbar spinal stenosis with vascular claudication

Background

The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC).

Methods

Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively.

Results

Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia.

Conclusions

The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

Physical and Psychological Factors Associated With Walking Capacity in Patients With Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Scoping Review

Objective: The purpose of this study was to evaluate the current state of scientific knowledge regarding physical and psychological factors associated with walking capacity in patients with lumbar spinal stenosis (LSS) with neurogenic claudication.

Design: Systematic scoping review.

Literature Search: We searched CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Cochrane, PsycINFO, and SPORTDiscus databases.

Study Selection Criteria: Cohorts and cross-sectional studies reporting on associations between physical or psychological factors and impaired walking capacity in patients with symptomatic LSS were included.

Data Synthesis: Data were synthetized to identify associations between physical or psychological factors and either walking capacity, gait pattern characteristics, or functional tasks.

Results: Twenty-four studies were included. Walking capacity was significantly correlated with several pain outcomes, disability, estimated walking distance, and cross-sectional area of the lumbar spine. Gait pattern characteristics such as speed and stride were strongly and positively correlated with disability outcomes. Functional tasks were significantly correlated with lower back and upper limb disability, lower limb endurance strength, ranges of motion, and speed. Associations with psychological factors were mostly conflicting except for the Rasch-based Depression Screener and the Pain Anxiety Symptom Scale (PASS-20) questionnaire that were associated with a decreased performance in functional tasks.

Conclusion: Physical and psychological factors that are associated with walking capacity in patients with symptomatic LSS were identified. However, many associations reported between physical or psychological factors and walking capacity were conflicting, even more so when correlated with walking capacity specifically.

Gait analysis in the elderly patients with lumbar spinal stenosis

PURPOSE

This study aims to analyze the gait characteristics of the elderly patients with lumbar spinal stenosis by an intelligent device for energy expenditure and activity (IDEEA) to assist clinical work.

METHODS

A total of 98 subjects were included in this study from January 2017 to December 2018. A total of 49 elderly outpatients with symptomatic lumbar spinal stenosis in unilateral lower extremity were included as the experimental group, and another 49 healthy subjects matched with gender, age, and body mass index (BMI) were analyzed as the control group. The gait data of the subjects (including single support, double support, SLS/DLS, swing duration, step duration, cycle duration, pulling accel, swing power, ground impact, foot fall, foot off, push off, speed, cadence, step length, and stride length) were collected to compare between the experience group and control group, the affected leg and the healthy leg in experimental group.

RESULTS

The results of this study presented that small intermittent claudication occurred in all patients. The time of single support was significantly increased (p < 0.05). Double support, step duration, and pulling accel were increased (p < 0.05), and the Push off, speed, step length, and Stride length were decreased (p < 0.05) in the experimental group compared with the control group.

CONCLUSION

Small intermittent claudication was the basic gait composition of the elderly patients with lumbar spinal stenosis that can reflect the abnormal gait characteristics by IDEEA.

Improvement of locomotive syndrome after total hip arthroplasty: A two-year longitudinal cohort study

OBJECTIVES

Patients requiring total hip arthroplasty (THA) may possibly have locomotive syndrome (LS). Therefore, we investigated changes of LS in patients undergoing THA and clarified key factors that affected LS stage.

METHODS

A prospective cohort study was conducted with 88 patients undergoing THA (74 females, 14 males, mean age: 67.6 years). Data collected using LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale results were evaluated before THA, and 6 months, 1 year, and 2 years after THA. Key factors were determined using multivariate analysis and receiver operating characteristic (ROC) curve analysis.

RESULTS

Before THA, all patients had fallen LS (stage1: 3.4% and stage2: 96.6%). Overall, 56.8% patients improved their LS stage, and 17.0% of patients overcame LS at 2 years after THA. The key factors that affected LS stage were preoperative two-step test and age. ROC analyses showed a preoperative two-step test score of 0.988 and an age of 67.5 years as a cut-off value for the change of LS stage.

CONCLUSIONS

Patients experiencing LS due to hip disorders have the potential to recover after THA. Additional postoperative training may be beneficial for patients with low preoperative two-step test scores to improve their LS stage.

Influence of the Sagittal Vertical Axis on the Risk of Falls in Community-Dwelling Elderly People: A Retrospective Longitudinal Study

Introduction

Falling is an age-related problem that increases with age. Compared with younger people, elderly people possess increased risk factors for falls, and falling among the elderly is associated with increased mortality. Risk factors for falls have been reported in elderly outpatients; however, whether sagittal spinal posture affect the risk of falls in community residents remains unclear. Therefore, we aimed to investigate the influence of sagittal spinal posture on the risk of falls in elderly community-dwelling people using spino-plevic sagittal parameters in a retrospective longitudinal study.

Methods

A total of 463 volunteers (96 men and 367 women; mean age, 72.8 years) who underwent a routine physical checkup were evaluated. Baseline whole spine and lower limb radiography, physical tests, bone mineral density (BMD), number of medications and comorbidities, patient-reported outcomes (PROs), and a history of falls in the previous four years period were examined.

Results

Univariate analysis revealed older age, lower height and weight, higher prevalence of vertebral fractures, higher number of medications, poor physical test scores including one-leg standing test and prone trunk extension, poor PROs, a higher sagittal vertical axis, and higher pelvic tilt (PT) as factors significantly associated with the risk of falls, and multivariate analysis revealed a higher sagittal vertical axis [odds ratio (OR), 1.08; 95% confidence interval (CI), 1.002-1.013; P = 0.02] and locomotive syndrome assessed using the 25-Question Geriatric Locomotive Function Scale score (OR, 1.028; 95% CI, 1.004-1.053; P = 0.03) to be associated with the risk of falls, independent of other factors in the univariate analysis.

Conclusions

The sagittal vertical axis was an independent risk factor for falls, and the prevalence of vertebral fractures and prone truck extension correlated with the sagittal vertical axis. Prospective and intervention studies are needed to prevent future falls in elderly community volunteers with a higher sagittal vertical axis.

Lumbar Spinal Canal Stenosis from the Perspective of Locomotive Syndrome and Metabolic Syndrome: A Narrative Review

Patients with lumbar spinal canal stenosis (LSS) have impaired activities of daily living because of pain or motor paralysis, but no effective preventive treatment is currently available. The number of patients with LSS is predicted to continually increase as the average age of the global population increases. To provide a conceptual framework for improving healthy life expectancy, the Japanese Orthopaedic Association introduced the concept of locomotive syndrome, to which LSS is related. Ours and other studies have shown that LSS exacerbates locomotive syndrome and that surgical treatment is one method for improving it. Furthermore, we propose that the two-step test, a locomotive syndrome risk test, is effective for assessing the risk for falls and severity of LSS. Meanwhile, lumbar spinal epidural lipomatosis (LSEL), which is a manifestation of LSS, has been shown to be related to metabolic syndrome. Previous studies have suggested that the whole LSS can be also associated with metabolic syndrome. Although locomotive syndrome is very different from metabolic syndrome, which involves lipid metabolism, these two syndromes overlap, such as in LSS. Conducting research on LSS from the perspectives of both locomotive syndrome and metabolic syndrome may lead to novel methods for prevention and treatment of LSS and, conversely, may yield clues for resolving symptoms of the two syndromes. This review provides an overview of LSS from the perspective of locomotive syndrome and metabolic syndrome, along with findings from our research group.

Improvement of locomotive syndrome with surgical treatment in patients with degenerative diseases in the lumbar spine and lower extremities: a prospective cohort study

Background

The epidemiology, risk factors, and prevention of locomotive syndrome (LS) have been reported. However, the number of clinical studies about the efficacy of LS treatment, including surgery, has been limited. This study aimed to evaluate LS and its improvement in patients undergoing surgeries for degenerative disease of the lumbar spine and lower extremities, and to discuss the effects of surgery on LS and the issues of LS assessment in these patients.

Methods

We enrolled 257 patients aged ≥60 years that underwent surgery for degenerative diseases of the lumbar spine and lower extremities and agreed to participate in the preoperative and 6- and 12-month postoperative LS examinations. According to the disease location, patients were divided into the lumbar (n = 81), hip (n = 106), knee (n = 43), and foot and ankle (n = 27) groups. Patients underwent LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25) assessment.

Results

The preoperative prevalence of LS stage 2 was 95%. Only the hip group showed significant improvements in the stand-up test. The knee group showed the worst results in the stand-up and two-step tests at all time points. All four groups had significant improvements in GLFS-25 scores. Approximately 40% of all patients had improvement in their LS stage postoperatively. However, > 90% of the patients in the knee group had LS stage 2 postoperatively.

Conclusion

Nearly all elderly patients requiring surgeries for degenerative diseases of the lumbar spine and lower extremities had advanced conditions (LS stage 2). Surgeries could be beneficial in alleviating LS. The LS stage 3 criteria should be established, and the use of the GLFS-25 assessment can be appropriate for advanced LS patients with severe musculoskeletal diseases requiring surgeries.

Lumbar spinal surgery improves locomotive syndrome in elderly patients with lumbar spinal canal stenosis: A multicenter prospective study

BACKGROUND

Owing to musculoskeletal dysfunction, locomotive syndrome elevates the risk of requiring nursing care. Among degenerative musculoskeletal disorders, lumbar spinal canal stenosis (LSS) associates with locomotive syndrome; however, whether lumbar spinal surgery for LSS improves locomotive syndrome remains unclear. Hence, this study aimed to identify the efficacy of lumbar spinal surgery on locomotive syndrome among elderly patients with LSS.

METHODS

We prospectively collected the clinical data from multiple institutions of patients (age >65 years) who underwent lumbar spinal surgery. Patients were examined for the locomotive syndrome risk test, including the stand-up Test, the two-step Test, and the 25-question risk assessment, 1-day preoperatively and 6-month and 1-year postoperatively. Using a logistic regression model, we identified factors associated with improvement of locomotive syndrome in the total assessment.

RESULTS

Overall, we examined the data of 166 patients in this study. Upon converting each score of three tests to the stage of locomotive syndrome, the two-step test and the 25-question risk assessment revealed marked improvement in the postoperative distribution of stages. However, the stand-up test revealed a comparable distribution of stages pre- and postoperatively. In the total assessment, the postoperative distribution of stages was significantly improved than that preoperatively. The multivariable analysis revealed that failed back surgery syndrome [odds ratio (OR), 0.2; 95% confidence interval (CI): 0.04-1.05; P = 0.057)] and preoperative stage of 2 in stand-up test (OR, 0.2; 95% CI: 0.05-1.02; P = 0.054) tended to have inverse association with postoperative improvement of locomotive syndrome in the total assessment.

CONCLUSIONS

Lumbar spinal surgery improved the stage of locomotive syndrome among elderly patients with LSS. This study suggests that lumbar spinal surgery for LSS could be beneficial in alleviating locomotive syndrome.