Arch Phys Med Rehabil. 2018 Jun 20. pii: S0003-9993(18)30362-9. doi: 10.1016/j.apmr.2018.05.014. [Epub ahead of print]
Ammendolia C1, Côté P2, Southerst D3, Schneider M4, Budgell B3, Bombardier C5, Hawker G5, Rampersaud YR6.
Highlights
- Effective non-surgical treatments for lumbar spinal stenosis are unknown.
- Limited walking ability is the dominant impairment in this population.
- We conducted a randomized trial that tested a 6-week comprehensive training program.
- The comprehensive program showed large and sustainable improvements in walking ability.
- 81% of comprehensive participants achieved the walking MCID at 12-months.
Abstract
OBJECTIVES:
To compare the effectiveness of a comprehensive non-surgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis.
DESIGN:
Randomized controlled trial.
SETTING:
Academic hospital outpatient clinic.
PARTICIPANTS:
A total of 104 participants with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were female, 84% had leg symptoms for more than 12-months and the mean maximum walking capacity was 328.7m.
INTERVENTIONS:
A six-week structured comprehensive training program or a six-week self-directed program.
MAIN OUTCOME MEASURES:
Continuous walking distance in meters (m) measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (MCID) in the SPWT at 6-months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score and the Short-Form General Health Survey (SF-36) subscales.
RESULTS:
Forty-eight verses 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment respectively, received the intervention and 89% of the total study sample completed the study. At 6-months the adjusted mean difference in walking distance from baseline was 421.0m (95% confidence interval (CI), 181.4 to 660.6;) favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID, (adjusted relative risk (RR), 1.3; 95% CI, 1.0 to1.7; P= 0.03). Both primary treatment effects persisted at 12-months favoring the comprehensive program. At 6-months the ODI walk score and at 12-months the ZCQ, SF-36 physical function and bodily pain scores showed greater improvements favoring the comprehensive program.
CONCLUSIONS:
A comprehensive conservative program demonstrated superior, large and sustained improvements in walking ability and can be a safe non-surgical treatment option for patients with neurogenic claudication due to LSS.
Copyright © 2018. Published by Elsevier Inc.