Comprehensive conservative intervention improves walking ability in lumbar spinal stenosis patients

Prevalence and economic burden of condition growing with aging population.
Lumbar spinal stenosis (LSS) is a leading cause of pain and disability in older adults, and its dominant functional impairment is limited walking ability. The prevalence and economic burden of LSS are growing rapidly because of the aging population, so optimizing treatment is essential. Most LSS patients undergo conservative care, but recent reviews have shown that the benefits of many conservative interventions on walking outcomes are not clearly proven. Therefore, a randomized-controlled trial was conducted to evaluate the effectiveness of a comprehensive conservative training program to for improving walking ability in LSS patients.

Patients regularly followed up for 12 months
Researchers recruited LSS patients and applied inclusion criteria, which led to 99 being accepted and randomly allocated to either the comprehensive or self-care group. The comprehensive conservative treatment program consisted of two weekly 15-20-minute sessions over six weeks, followed by one booster session. Each session included an education, exercise, and manual therapy component. The exercise program included 18 stretching, strengthening, and conditioning exercises to improve back and lower extremity fitness, while manual therapy included various mobilizations/manipulations intended to reduce pain and improve flexibility. Both groups were also given a pedometer, instructional video, and workbook, but the self-care group did not receive any other interventions. All patients were assessed with a self-paced walking test (SPWT) and several secondary outcome measures at baseline and then at three-week, eight-week, three-month, six-month, and 12-month follow-ups.

Conservative treatments beneficial for LSS patients
Although both groups improved in the SPWT at each of the follow-ups, the comprehensive group demonstrated more statistically and clinically significant improvements than the self-care group. At each follow-up, the proportion of participants who improved their walking distance by at least 30% was significantly higher in the comprehensive group, and at six months, 82% of comprehensive and 63% of self-care participants reached this mark. The comprehensive group also reported significantly higher scores in a number of other secondary outcome measures, such pain and function. Based on these findings, it appears that a comprehensive conservative treatment program is a safe approach that can lead to a number of clinical benefits for LSS patients. Additional research is needed, but clinicians are still encouraged to refer these patients to physical therapy, where they can undergo these treatments and strive towards positive outcomes with more independence.

-Summarized by Greg Gargiulo

-As reported in the May ’18 issue of Archives of Physical Medicine and Rehabilitation