Role of questionnaire as subjective routine assessment of rehabilitation success in lumbar spinal stenosis patients: systematic review and meta-analysis

Patient-reported questionnaires are widely used to evaluate symptoms and outcomes of lumbar spinal stenosis (LSS), but their diagnostic accuracy has not been consistently summarized. Random-effects models were used to pool sensitivity and specificity estimates. Heterogeneity was assessed with the I2 statistic, and publication bias with funnel plots, Egger’s test, and Begg’s test. Nineteen studies were included. Pooled sensitivity was 0.80 (95% CI: 0.74–0.85) and specificity 0.76 (95% CI: 0.72–0.80). The Lumbar Spinal Stenosis-Diagnostic Support Tool (LSS-DST) showed the highest sensitivity (0.91) but moderate specificity (0.76). The Zürich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) also demonstrated high sensitivity (0.87) and good specificity (0.83 and 0.78). The EuroQol 5-Dimension (EQ-5D-3L) and the 12-Item Short Form Health Survey (SF-12) had the lowest sensitivities (0.59 and 0.63). The Self-administered Spinal Stenosis History Questionnaire (SSHQ) showed variable specificity (0.74, I2 = 98.10%). Heterogeneity was substantial (I2 = 98.68% for sensitivity; 96.32% for specificity). Funnel plots appeared symmetrical; Egger’s test was not significant (p = 0.19), while Begg’s test indicated possible small-study effects (p = 0.027). Most questionnaires for LSS show moderate-to-high diagnostic accuracy, with LSS-DST, ZCQ, and JOABPEQ performing best. Rehabilitation is a key component in the long-term management of patients with lumbar spinal stenosis (LSS), where appropriate assessment tools are essential for guiding treatment decisions and monitoring outcomes.Disease-specific questionnaires such as the Zürich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) demonstrate higher diagnostic accuracy and may be preferred for routine clinical assessment of patients with LSS.Generic measures (EuroQol 5-Dimension (EQ-5D), 12-Item Short Form Health Survey (SF-12)) show lower sensitivity and are better suited for evaluating quality-of-life outcomes rather than for diagnostic purposes.The choice of patient-reported outcome measures (PROMs) should be tailored to clinical goals: LSS-DST for screening, ZCQ/JOABPEQ for balanced diagnosis and follow-up, and generic tools for broader outcome monitoring. Rehabilitation is a key component in the long-term management of patients with lumbar spinal stenosis (LSS), where appropriate assessment tools are essential for guiding treatment decisions and monitoring outcomes. Disease-specific questionnaires such as the Zürich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) demonstrate higher diagnostic accuracy and may be preferred for routine clinical assessment of patients with LSS. Generic measures (EuroQol 5-Dimension (EQ-5D), 12-Item Short Form Health Survey (SF-12)) show lower sensitivity and are better suited for evaluating quality-of-life outcomes rather than for diagnostic purposes. The choice of patient-reported outcome measures (PROMs) should be tailored to clinical goals: LSS-DST for screening, ZCQ/JOABPEQ for balanced diagnosis and follow-up, and generic tools for broader outcome monitoring.