title: ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.
abstract: METHODS
  Delphi.
  
  
  OBJECTIVE
  The aim of this study was to obtain an expert consensus on which history factors are most important in the clinical diagnosis of lumbar spinal stenosis (LSS).
  
  
  BACKGROUND
  LSS is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.
  
  
  METHODS
  Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An online survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.
  
  
  RESULTS
  A total of 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were "leg or buttock pain while walking," "flex forward to relieve symptoms," "feel relief when using a shopping cart or bicycle," "motor or sensory disturbance while walking," "normal and symmetric foot pulses," "lower extremity weakness," and "low back pain." Significant change in certainty ceased after six questions at 80% (P < .05).
  
  
  CONCLUSIONS
  This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of "seven history items" that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long term may lead to more cost-effective treatment, improved health care utilization, and enhanced patient outcomes.
  
  
  METHODS
  2.
authors.affiliation: Department of Health and Physical Education, Mount Royal University, Calgary, Canada.
authors.forename: Christy
authors.initials: C
authors.lastname: Tomkins-Lane
authors.affiliation: Department of Public Health, Zurich University of Applied Sciences, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Melloh
authors.affiliation: Department of Orthopaedic Surgery, Dartmouth University, Hanover, NH.
authors.forename: Jon
authors.initials: J
authors.lastname: Lurie
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
authors.forename: Matt
authors.initials: M
authors.lastname: Smuck
authors.affiliation: Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Battié
authors.affiliation: Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Freeman
authors.affiliation: Department of Orthopaedics and Traumatology, University of Hong Kong.
authors.forename: Dino
authors.initials: D
authors.lastname: Samartzis
authors.affiliation: Department of Surgery, University of Calgary, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Hu
authors.affiliation: Department of Orthopaedics and Traumatology, Asklepios Gemeinsam für Gesundheit, Schwedt, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Barz
authors.affiliation: Canadian Memorial Chiropractic College, Calgary, AB, Canada.
authors.forename: Kent
authors.initials: K
authors.lastname: Stuber
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.
authors.forename: Andrew
authors.initials: A
authors.lastname: Haig
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, University Hospital of Lausanne, Switzerland.
authors.forename: Constantin
authors.initials: C
authors.lastname: Schizas
authors.affiliation: Department of Orthopaedics and Traumatology, University of Hong Kong.
authors.forename: Jason Pui Yin
authors.initials: JPY
authors.lastname: Cheung
authors.affiliation: Spine Center, Schulthess Klinik, Zurich.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Mannion
authors.affiliation: Institute for Evaluative Research in Orthopaedic Surgery, University of Berne, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Staub
authors.affiliation: Musculoskeletal Service, Leeds Community Healthcare Trust, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Comer
authors.affiliation: Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada.
authors.forename: Luciana
authors.initials: L
authors.lastname: Macedo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Yeungnam University, Gyeongsan, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Chiba University, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.
authors.forename: Danielle
authors.initials: D
authors.lastname: Sandella
mesh_terms: D001363:Awards and Prizes; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000601:surgery*; D009422:Nervous System Diseases / Q000175:diagnosis; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000628:therapy; D011795:Surveys and Questionnaires
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