Family Practice Advance Access originally published online on June 13, 2008
Family Practice 2008 25(4):237-244; doi:10.1093/fampra/cmn031
Predictive value of self-reported patient information for the identification of lumbar spinal stenosis
a Department of Epidemiology and Health Care Research, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
b Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, Japan
c Institute for Health Outcomes and Process Evaluation Research, Kyoto, Japan
Correspondence to Yasuaki Hayashino, Department of Epidemiology and Health Care Research, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Email: hayasino-y{at}umin.net
Received 10 October 2007; Accepted 18 May 2008.
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Abstract |
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Background. To our knowledge, no objective criterion has been identified for the diagnosis of lumbar spinal stenosis (LSS) and no study has evaluated the predictive value of self-reported patient information for the identification of LSS.
Objective. To develop and validate a prediction rule for the identification of LSS based on self-reported patient information alone.
Methods. Prospective derivation study using a coefficient-based multivariable logistic regression scoring method with internal validation with primary care clinics and orthopaedic departments of medical centres, as well as university and other hospitals. Participants were consecutive patients with primary symptoms of pain or numbness in the lower extremities. Physician-diagnosed LSS was the main outcome measure.
Results. Of 468 patients included in the analysis, 47.3% were diagnosed with LSS and divided into derivation and validation sets. The following items were retained at the conclusion of the derivation process: age (<60, 60–70 and >70), duration of symptoms over 6 months, symptom improvement when bending forward, symptom improvement when bending backward, symptom exacerbation while standing up, intermittent claudication and urinary incontinence. To derive a risk score for each patient, integer-based scores were assigned and summed. In the validation data sets, prevalence of LSS in patients from the first to fourth risk score quartile were 13.3%, 47.6%, 55.2% and 65.5%, respectively. Further, the likelihood ratio in the low-risk category was 0.154.
Conclusions. We developed a prediction rule for the identification of LSS based on self-reported patient information alone. Further, the likelihood ratio in the low-risk category was sufficiently low. This rule may be used for screening of LSS.
Keywords. Lumbar spinal stenosis, prediction rule, self-reported patient information.
Sugioka T, Hayashino Y, Konno S, Kikuchi S and Fukuhara S. Predictive value of self-reported patient information for the identification of lumbar spinal stenosis. Family Practice 2008; 25: 237–244.