Highlights
- •Impairments associated with mobility for patients with lumbar stenosis is not well-defined.
- •Patients with stenosis experience a greater severity of impairments.
- •Trunk extensor endurance, leg strength, and knee flexion ROM are associated with a decline in mobility.
Abstract
Objectives
To identify neuromuscular attributes associated with mobility and changes in mobility
over 2 years of follow-up among patients with and without symptomatic lumbar spinal
stenosis (SLSS).
Design
Secondary analysis of a longitudinal cohort study.
Setting
Outpatient rehabilitation center.
Participants
Community-dwelling older adults ≥65 years with self-reported mobility limitations
(N=430). SLSS was determined using self-reported symptoms of neurogenic claudication
and imaging-detected lumbar spinal stenosis.
Interventions
Not applicable.
Main Outcome Measure
Basic and advanced mobility as measured by the Late-Life Function and Disability Instrument
(LLFDI).
Results
Among 430 community-dwelling older adults, 54 (13%) patients met criteria for SLSS,
while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased
significantly from baseline through year 2 for participants with SLSS (basic: P=.04, 95% CI 0.18, 5.21; advanced P=.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg
strength were associated with baseline basic mobility (R2=0.27, P<.001) while leg strength and knee flexion range of motion (ROM) were associated with
baseline advanced mobility among participants with SLSS (R2=0.47, P<.001). Among participants without SLSS trunk endurance, leg strength and ankle ROM
were associated with baseline basic mobility (R2=0.38, P<.001), while trunk endurance, leg strength, leg strength asymmetry, and knee flexion
ROM were associated with advanced mobility (R2=0.20, P<.001). Trunk endurance and leg strength were associated with change in basic mobility
(R2=0.29, P<.001), while trunk endurance and knee flexion ROM were associated with change in
advanced mobility (R2=0.42, P<.001) among participants with SLSS. Among participants without SLSS trunk endurance,
leg strength, knee flexion ROM, and ankle ROM were associated with change in basic
mobility (R2=0.22, P<.001), while trunk endurance, leg strength, and knee flexion ROM were associated
with change in advanced mobility (R2=0.36, P<.001).
Conclusions
Patients with SLSS experience greater impairment in the neuromuscular attributes:
trunk endurance, leg strength, leg strength asymmetry, knee flexion and extension
ROM, and ankle ROM compared to patients without SLSS. Differences exist in the neuromuscular
attributes associated with mobility at baseline and decline in mobility over 2 years
of follow-up for patients with and without SLSS. These findings may help guide rehabilitative
care approaches for patients with SLSS.
Keywords
List of abbreviations:
BMI (body mass index), Boston RISE (Boston Rehabilitative Study of the Elderly), CT (computed tomography), EMR (electronic medical record), LLFDI (Late-Life Function and Disability Instrument), LSS (lumbar spinal stenosis), ROM (range of motion), SLSS (symptomatic lumbar spinal stenosis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 10, 2018
Footnotes
Current affiliation for Schmidt, Center on Health Services Training and Research (CoHSTAR), School of Public Health, Brown University, Providence, RI.
This study was performed at Spaulding Rehabilitation Hospital, Cambridge, MA.
Supported by grants from Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant no. 1K24HD070966), National Institute on Aging (grant nos. R01 AG032052 and T32AG023480); the National Center for Research Resources in a grant to the Harvard Clinical and Translational Science Center (grant no. UL1 RR025758); and a Departmental Research Grant Award from the Department of Orthopedics, Beth Israel Deaconess Medical Center. These funding supports did not have a direct role in the study design, collection, analysis or interpretation of data, writing, or submission decisions for this manuscript.
Disclosures: J. Bean reports grants from NIH during the conduct of the study and grants from NIH and grants from RX Foundation outside the submitted work. P. Suri reports personal fees from Spaulding Rehabilitation Hospital during the conduct of the study. D.E. Anderson reports grants from American Society for Bone and Mineral Research outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
