Response to: Evaluating the Reproducibility of the Walking Test for Intermittent Claudication Associated with Lumbar Spinal Stenosis

Shinji Tanishima; Li Weishi; Hu Jianzhong; Zhao Jie; Yang Huilin; Hideki Nagashima

doi:10.31616/asj.2022.0290.r2

Letter to the Editor

Asian Spine Journal 2022;16(4):613-614.

Online first: August 23, 2022

DOI: https://doi.org/10.31616/asj.2022.0290.r2

Response to: Evaluating the Reproducibility of the Walking Test for Intermittent Claudication Associated with Lumbar Spinal Stenosis

Shinji Tanishima¹, Li Weishi², Hu Jianzhong³, Zhao Jie⁴, Yang Huilin⁵, Hideki Nagashima¹

¹Division of Orthopaedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan

²Department of Orthopaedics, Peking University Third Hospital, Beijing, China

³Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China

⁴Department of Orthopaedics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

⁵Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China

Corresponding author: Shinji Tanishima Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
Tel: +81-859-38-6587, Fax: +81-859-38-6589, E-mail: shinjit@tottori-u.ac.jp

Received August 1, 2022 Accepted August 8, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

See the letter "Letter to the Editor: Evaluating the Reproducibility of the Walking Test for Intermittent Claudication Associated with Lumbar Spinal Stenosis" on page 611.

Thank you for reading our paper. “Evaluating the reproducibility of the walking test for intermittent claudication associated with lumbar spinal stenosis [1].”

(1) This participants of this study with symptoms of both lower extremities and only those with cauda equina or mixed symptoms. Although not presented in the paper, the evaluation of root pain in individual cases showed that 19 cases improved, while 51 cases remained unchanged or worsened. Given the small number of improved cases and the intraclass correlation coefficient for pain Visual Analog Scale (VAS) of 0.67, we believe that a 4-week period is not necessarily an inappropriate period to evaluate reproducibility.

As for differences in reproducibility by symptom type in the lumbar spinal stenosis (LSS), the intraclass correlation coefficients for leg pain VAS, leg numbness VAS, and walking distance are around 0.7, as shown in the results. Overall, we consider that there is no difference in reproducibility depending on the type of symptoms.

(2) Certainly, if we could objectively evaluate the gait posture, we would be able to evaluate the reproducibility in more detail.

(3) As shown in Table 1 of our paper [1], only three of 70 patients (4.3%) were receiving medication for LSS at the time of baseline. These three patients stopped active drug treatment during the study and all patients were on vitamin B12 medication only. This does not appear to have affected the overall results.

(4) In the present study, we did not evaluate detailed changes in physical findings before and after the gait test as in previous reports [2].