Reliable outcome parameters in patients with lumbar radiculopathy attributed to disc herniation: An observational study

Giannina Bianchi^1*Christian Zweifel²Erich Hohenauer^1,3,4,5Joseph Alvin Ramos Santos⁶Ron Clijsen^1,3,5,7

• ¹Rehabilitation and Exercise Science Laboratory (RESlab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Landquart, Switzerland
• ²Departement of Neurosurgery, Kantonsspital Graubunden, Chur, Switzerland
• ³THIM Internationale Hochschule fur Physiotherapie, Landquart, Switzerland
• ⁴Department of Neurosciences and Movement Science, Universite de Fribourg, Fribourg, Switzerland
• ⁵Departement of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
• ⁶Department of Business Economics, Health and Social Care (DEASS), Scuola universitaria professionale della Svizzera italiana, Manno, Switzerland
• ⁷Departement of Health, Universitat Bern, Bern, Switzerland

Introduction: Evidence regarding the diagnostic accuracy of physical assessments and patient-reported outcome measures in lumbar disc herniation with radiculopathy remains inconclusive. This study aimed to evaluate whether selected patient-reported outcome measures and physical assessments accurately reflect treatment progress, regardless of whether the treatment was conservative only or combined with surgery. Methods: Mobility, isometric strength, pain, numbness, paresthesia, Oswestry Disability Index, International Physical Activity Questionnaire, straight-leg raising test, and the Short Form-36 Health Survey physical and mental components were recorded at baseline, after six weeks, and at six months. Results: At six weeks (n = 19), significant improvements were observed in the straight-leg raising test (mean difference: 10.53, 95% CI: 1.25 to 19.81, p = 0.02), the Short Form-36 Health Survey physical component score (9.06, 95% CI: 4.23 to 13.90, p < 0.001), and the mental component score (10.29, 95% CI: 4.81 to 15.76, p < 0.001), pain sensation (-2.46, 95% CI: -3.99 to -0.93, p < 0.001), paresthesia (-2.36, 95% CI: -3.73 to -0.99, p < 0.001), numbness (-1.35, 95% CI: -2.56 to -0.14, p = 0.023), and in the Oswestry Disability Index score (-20.42, 95% CI: -28.04 to -12.80, p < 0.001). At six months (n = 15), significant benefits were noted in anterior flexion (-8.19, 95% CI: -13.42 to -2.96, p = 0.001), back extension (9.35, 95% CI: 4.52 to 14.18, p < 0.001), and muscle strength in the affected leg (tibialis anterior muscle: 44.27, 95% CI: 4.72 to 83.81, p = 0.024; extensor hallucis longus muscle: 16.58, 95% CI: 2.60 to 30.56, p = 0.02). No significant changes occurred in lateral flexion left or right, strength in the unaffected leg, or the International Physical Activity Questionnaire. Conclusion: The exploratory findings of this study indicate that subjective outcomes improve earlier than objective measures. These findings emphasize the value of combining subjective and objective methods to monitor treatment outcomes and assess progress effectively. Larger studies with more participants, frequent evaluations, and longer follow-up are needed to clarify recovery patterns, determine the most sensitive outcome measures, and define minimal clinically important differences for patients with lumbar disc herniation with radiculopathy.