Objective physical performance and exercise tests of patients with lumbar spinal stenosis: a systematic scoping...

Lumbar spinal stenosis (LSS) affects a considerable portion of global population and is one of the main reasons for lumbar spine surgery in individuals over the age of 65. Diagnosing LSS remains challenging due to a lack of universally accepted criteria and a weak correlation between imaging severity and symptoms. Functional assessment, including standardized treadmill or walking tests, is recommended. While self-reported questionnaires are commonly used, objective exertion tests are also important for assessing symptom severity and treatment outcomes. This study aims to evaluate and map the scientific knowledge on objective physical performance and exercise tests for patients with LSS.

This scoping review followed the Joanna Briggs Institute methodology and is reported in accordance with the PRISMA-ScR guidelines. A protocol was registered on open science framework (OSF). The review question was informed by the Population-Concept-Context framework. A systematic search of CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Cochrane, Embase, Web of Science, and Scopus was conducted from inception to December, 2025. Two reviewers independently screened studies against predefined eligibility criteria and extracted data using a standardized charting form. Findings were synthesized narratively and presented in tabular and graphical formats.

57 studies met the inclusion criteria. In most studies, the diagnosis of LSS was made using a combination of clinical assessments, such as the patient's history and/or physical examination, along with MRI findings. After reviewing the literature on exertional tests for patients with lumbar spinal stenosis and extracting the relevant data, the tests were grouped into six categories: walking tests, treadmill tests, cycling tests, standing lumbar extension tests, accelerometer testing, and other functional mobility and balance tests.

Exertional tests in patients with LSS have diagnostic, evaluative, and rehabilitative value, supporting both clinical decision-making and outcome assessment. Among available methods, walking tests, particularly those quantifying neurogenic claudication, are the most valid and reliable objective measures. Accelerometer-based assessments effectively capture ambulation capacity, while treadmill and standing lumbar extension tests show promise but require further validation. Additional research is needed to standardize protocols and determine how disability severity influences test selection and performance outcomes.

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