Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures

PLOS ONE RESEARCH ARTICLE Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Katie L. Kowalski ID1,2*, Jai Mistry1,3, Anthony Beilin1, Maren Goodman4, Michael J. Lukacs ID1,5, Alison Rushton1 1 School of Physical Therapy, Western University, London, Ontario, Canada, 2 Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada, 3 Physiotherapy, St George’s Hospital, London, United Kingdom, 4 Western Libraries, Western University, London, Ontario, Canada, 5 Physiotherapy Department, London Health Sciences Centre, London, Ontario, Canada * OPEN ACCESS Citation: Kowalski KL, Mistry J, Beilin A, Goodman M, Lukacs MJ, Rushton A (2024) Physical functioning in the lumbar spinal surgery population: A systematic review and narrative synthesis of outcome measures and measurement properties of the physical measures. PLoS ONE 19(8): e0307004. https://doi.org/10.1371/journal. pone.0307004 Editor: Emad A. Aboelnasr, Cairo University Faculty of Physical Therapy, EGYPT Abstract Background International agreement supports physical functioning as a key domain to measure interventions effectiveness for low back pain. Patient reported outcome measures (PROMs) are commonly used in the lumbar spinal surgery population but physical functioning is multidimensional and necessitates evaluation also with physical measures. Received: March 19, 2024 Objective Accepted: June 26, 2024 1) To identify outcome measures (PROMs and physical) used to evaluate physical functioning in the lumbar spinal surgery population. 2) To assess measurement properties and describe the feasibility and interpretability of physical measures of physical functioning in this population. Published: August 29, 2024 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0307004 Copyright: © 2024 Kowalski et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Study design Two-staged systematic review and narrative synthesis. Methods This systematic review was conducted according to a registered and published protocol. Two stages of searching were conducted in MEDLINE, EMBASE, Health & Psychosocial Instruments, CINAHL, Web of Science, PEDro and ProQuest Dissertations & Theses. Stage one included studies to identify physical functioning outcome measures (PROMs and physical) in the lumbar spinal surgery population. Stage two (inception to 10 July 2023) included studies assessing measurement properties of stage one physical measures. Two PLOS ONE | https://doi.org/10.1371/journal.pone.0307004 August 29, 2024 1 / 36 PLOS ONE Systematic review of physical functioning outcome measures and measurement properties of the physical measures information files. No identifying information is found within the manuscript or Supporting information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. independent reviewers determined study eligibility, extracted data and assessed risk of bias (RoB) according to COSMIN guidelines. Measurement properties were rated according to COSMIN criteria. Level of evidence was determined using a modified GRADE approach. Results Stage one included 1,101 reports using PROMs (n = 70 established in literature, n = 67 developed by study authors) and physical measures (n = 134). Stage two included 43 articles assessing measurement properties of 34 physical measures. Moderate-level evidence supported sufficient responsiveness of 1-minute stair climb and 50-foot walk tests, insufficient responsiveness of 5-minute walk and sufficient reliability of distance walked during the 6-minute walk. Very low/low-level evidence limits further understanding. Conclusions Many physical measures of physical functioning are used in lumbar spinal surgery populations. Few have investigations of measurement properties. Strongest evidence supports responsiveness of 1-minute stair climb and 50-foot walk tests and reliability of distance walked during the 6-minute walk. Further recommendations cannot be made because of very low/low-level evidence. Results highlight promise for a range of measures, but prospective, low RoB studies are required. Introduction Musculoskeletal low back pain (LBP) persists as a leading global cause of disability from adolescence to old age [1]. It is the most prevalent condition requiring effective rehabilitation [2] with best-evidence guidelines recommending interventions focused on self-management, physical and psychological therapies [3, 4]. For appropriate clinical indications, surgical interventions are effective in reducing pain and enhancing physical functioning [3, 5]. Selecting appropriate outcome measures for the lumbar spinal surgery population is important as population-specific outcome measures are recommended for use when measuring treatment outcomes for specific clinical populations and when focusing on the individual, an important component of providing patient-centered care [6, 7]. International agreement supports physical functioning as the most important outcome domain to measure effectiveness of interventions for LBP [8]. Physical functioning is the impact of a condition on physical activities of daily living (e.g., walking ability, performance status, disability index) [9]. Use of patient reported outcome measures (PROMs) to evaluate physical functioning in LBP is common, despite low to very low quality evidence for their content validity [10]. The Oswestry Disability Index (ODI) is most commonly used/recommended in LBP and lumbar spinal surgery [11, 12]. However, previous systematic reviews have highlighted a breadth of PROMs are used to evaluate physical functioning in LBP and lumbar spinal surgery populations [12, 13]. As these systematic reviews were either conducted over 20 years ago [13] or with a limited search strategy [12], a contemporary and comprehensive search of the literature will enable wider considerations of PROMs to evaluate physical functioning in lumbar spinal surgery populations. Physical functioning is a multidimensional construct and necessitates evaluation with physical outcome measures, including impairments (e.g., strength), performance on a PLOS ONE (...truncated)