Relationship between Symptoms and Functional Limitation in Patients with Degenerative Lumbar Spinal Stenosis
廖健芬(Chien-Fen Liao)；林桑伊(Sang-I Lin)；林瑞模(Ruey-Mo Lin)
退化性腰椎脊髓腔壓迫 ； 症狀 ； 功能限制 ； Degenerative lumbar spinal stenosis ； Symptom ； Functional limitation
|Volume or Term/Year and Month of Publication||
31卷1期（2006 / 02 / 01）
33 - 38
背景與目的：本研究探討退化性腰椎脊髓腔壓迫所產生的症狀和功能限制的相關性，以了解是否臨床上所量測到的症狀可以用來反映功能表現，藉此來區辨病人是否為功能限制的高危險群。方法：本研究共收集並記錄了44位退化性腰椎脊髓腔壓迫病人的相關基本資料、症狀表現與日常活動功能情況。在症狀方面，包括症狀的型態（痠、痛、麻、無力或是緊繃），症狀的強度（5分制的口語強度量表），症狀開始的時間，以及有無神經性跛行(neurogenic claudication)。功能上的測量包括Oswestry disability index (ODI)和physical function scale (PFS)，其中ODI是用來測量因下背痛造成的失能情形，PFS則是有關行走能力的評估。結果：ODI與疼痛的有無具有正相關性(r=0.382, p=0.011)，也與症狀的強度有正相關(r=0.459, p=0.002)。PFS也與疼痛的有無(r＝-0.369, p=0.014)及症狀的強度有負相關(r＝-0.561, P=0.000)。回歸分析的結果發現，症狀的強度是ODI (R^2=0.211, P=0.002)及PFS (R^2=0.306, P=0.000)最有意義的預測因子。結論：當退化性腰椎脊髓腔壓迫的病人在症狀強度有較高的得分，則此病人在日常生活活動和行走方面可能會有較嚴重的功能限制。臨床上，建議使用症狀的強度這個項目來篩檢病人，得分較高的病人需仔細評估日常生活功能，以期能達預防與治療之效。
Background and Purposes: Degenerative lumber spinal stenosis is a common cause of pain, numbness and neurogenic claudication in older adults. Usually, clinical management focuses mainly on these symptoms. Functional limitations often accompany this problem, but are typically overlooked clinically. A better understanding in factors associated functional limitation will help clinicians to identify patients at risk. The aim of this study was to investigate the relationship between symptoms and functional limitation. Methods: Forty-four patients with degenerative lumbar spinal stenosis were recruited for the study. The symptoms investigated included nature (soreness, pain, numbness, weakness, tightness and neurogenic claudication), symptom intensity (verbal rating scale, rank from 1 to 5) and onset duration. Functional capacity was measured by Oswestry Disability Index (ODI), and Physical Function Scale (PFS). The ODI includes ten items related to the activities of daily living and was used to assess functional disability resulting from lower back pain. The PFS included five items which indicated the ability of ambulation. Correlation analysis was used to determine the association between the symptoms and the functional capacity. Regression analyses were conducted entering symptoms as independent variables, and ODI and PFS as dependent variables. Results: The presence of pain was significantly correlated with ODI (r=0.382, p=0.011) and PFS (r=-0.369, p=0.014). Symptom intensity was also significantly related to ODI (r=0.459, p=0.002) and PFS (r=-0.561, p=0.000). Symptom intensity was the most powerful predictor of ODI (R^2=0.211, p=0.002) and PFS (R^2=0.306, p=0.000). Conclusions: Among the various symptoms reported by patients with degenerative lumbar spinal stenosis, having pain as the primary symptom, and when the intensity of the primary symptom was higher were found to be associated with greater functional and walking limitation. Thus, these two specific symptoms could potentially serve as an indication for a need of screening functional capacity. Clinically, pain and symptom intensity may be used to screen patients for higher risk of functional limitation.