Execution
- 1Ask whether the patient has bilateral lower-extremity symptoms.
- 2Confirm whether lower-extremity pain is present.
- 3Ask whether pain occurs with walking or standing and is relieved by sitting.
- 4Record whether the patient is older than 48 years.
- 5Check whether there is no pain when seated and count the number of positive findings.
Positive outcome
The rule is positive when several of the five features are present. Four or more positive findings strongly increase suspicion for lumbar spinal stenosis or neurogenic claudication. Zero positive findings makes symptomatic lumbar spinal stenosis less likely.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Cook et al. (2011) | NA | NA | 98 | 4.6 | NA |
| Cook et al. (2020) — systematic review | NA | NA | NA | NA | NA |
CommentThis is a history-heavy diagnostic support rule, not a single physical test. It is strongest when the clinical syndrome is neurogenic claudication and imaging is interpreted in context, because stenosis on imaging is common in older adults. The reported LR+ is useful but not definitive, so gait, neurological examination, and response to flexion should still be considered.
High Clinical Value