Questionnaires or the Timed-up-and-go-(TUG)-test for the Assessment of Pain, Functional Disability and Health-related Quality of Life – A Patient's Preference

Aims: Assessment of pain, functional disability, and health-related quality of life (HRQoL) using validated questionnaires serves the preoperative evaluation and postoperative follow-up of patients undergoing surgery for lumbar degenerative disc disease (DDD), but is perceived time-consuming by many. The timed-up-and-go (TUG) test records the time needed to get up from a chair, walk a distance of two times three meters and sit down again. It represents a quick and easy-to-perform test for objective functional assessment. The current study is a survey of patients' preference – questionnaires versus TUG test. Methods: In a prospective observational two-center study, patients undergoing surgery for lumbar DDD received a comprehensive assessment preoperatively as well as on postoperative days one and three. It included the visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), Roland–Morris Disability Index (RMDI), EuroQol 5D (EQ-5D) and Short-Form 12 (SF-12) as well as the TUG test. After completion of each assessment, patients were asked whether they would prefer filling out the questionnaires or performing the TUG test. Results: Out of a preliminary sample of n = 109 patients, 60% stated preoperatively that they preferred the TUG test over the questionnaires. Neither age (median 68.5 vs. 63.9 years, p = 0.931), gender (53% female vs. 41% female, p = 0.694), comorbidity (Charlson comorbidity index 0.5 vs. 0.7, p = 0.249) nor body mass index (25.9 vs. 26.4 kg/m², p = 0.102) were influential factors on patients' preference. Also, pain (VAS back pain 4.0 vs. 3.5, p = 0.980 and VAS leg pain 4.0 vs. 4.2, p = 0.835), functional disability (RMDI 10 vs. 13, p = 0.084 and ODI 50 vs. 55, p = 0.249), HRQoL (SF-12 PCS 30.8 vs. 28.9, p = 0.181 and SF-12 MCS 44.7 vs. 44.3, p = 0.870 and EQ-5D 0.570 vs. 0.472, p = 0.418) and TUG scores (9.0 vs. 8.4 second., p = 0.636) were equally distributed in patients preferring one test over the other. On postoperative day one, 70% of the patients preferred the TUG test, in particular those with lower VAS leg pain (0 vs. 1.5, p = 0.001), lower functional disability (RMDI 9.0 vs. 16.0, p = 0.003) and better TUG scores (10.7 vs. 12.1 second, p = 0.074). On postoperative day three, 69% of the patients preferred the TUG test (no group differences). Conclusions: The TUG test seems to be a well-accepted objective functional assessment in patients with lumbar DDD. It is preferred over a battery of questionnaires by ∼60 to 70% of our patients.