• Martin N Stienen, Nicolas R Smoll, Holger Joswig, Jan Snagowski, Marco V Corniola, Karl Schaller, Gerhard Hildebrandt, and Oliver P Gautschi.
• Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland; Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland. Electronic address: mnstienen@gmail.com.
• Spine J. 2017 Jun 1; 17 (6): 807-813.

Background ContextThe Timed Up and Go (TUG) test has recently been proposed as a simple and standardized measure for objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD).PurposeThe study aimed to explore the relationship between a patient's mental health status and both patient-reported outcome measures (PROMs) and TUG test results.Study Design/SettingThis is a prospective institutional review board-approved two-center study.Patient SampleThe sample was composed of 375 consecutive patients scheduled for lumbar spine surgery and a healthy cohort of 110 control subjects.Outcome MeasuresPatients and control subjects were assessed with the TUG test and a comprehensive panel of subjective PROMs of pain intensity (visual analog scale [VAS]), functional impairment (Roland-Morris Disability Index [RMDI]), Oswestry Disability Index [ODI]), as well as health-related quality of life (hrQoL; Euro-Qol [EQ]-5D).MethodsStandardized age- and sex-adjusted TUG test T-scores were calculated. The dependent variable was the short-form (SF)-12 mental component summary (MCS) quartiles, and the independent variables were the TUG T-scores and PROMs. Direct and adjusted analyses of covariance were performed to estimate the interaction between the SF-12 MCS quartiles and the independent variables.ResultsIn patients, there was a significant decrease in the subjective PROMs, notably the VAS back pain (p=.001) and VAS leg pain (p=.035), as well as significant increase in the RMDI (p<.001), ODI (p<.001), and the EQ-5D index (p<.001) with every increase in the quartile of the SF-12 MCS. There were no significant group differences of OFI as measured by the TUG T-scores across the SF-12 MCS quartiles (p=.462). In the healthy control group, a significant decrease in VAS leg pain (p=.028), RMDI (p=.013), and ODI (p<.001), as well as a significant increase in the EQ-5D index (p<.001), was seen across the SF-12 MCS quartiles, whereas TUG T-scores remained stable (p=.897).ConclusionsThere are significant influences of mental hrQoL on subjective measures of pain, functional impairment, and hrQoL that might lead to bias when evaluating patients with lumbar DDD who suffer from reduced mental hrQoL. The TUG test appears to be a stable instrument and especially helpful in the evaluation of patients with lumbar DDD and mental health problems.Copyright © 2016 Elsevier Inc. All rights reserved.

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