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Minetama M1, Nakagawa M1, Yamamoto Y1, Matsuo S1, Koike Y1, Sakon N1, Nakatani T1, Sumiya T1, Nakagawa Y1, Teraguchi M1, Kagotani R1, Mera Y1, Kitano T1, Kawakami M1
1Wakayama Medical University Kihoku Hospital, Spine Care Center, Katsuragi-cho, Ito-gun, Japan
Background: Exercise for patients with lumbar spinal stenosis (LSS) has been reported to lead to better short-term outcomes in terms of disability and back and leg pain than no exercise. However, no reports have compared supervised exercise with unsupervised exercise or quantified physical activity using a pedometer to confirm compliance with the home exercise program.
Purpose: The purpose of this study was to compare the effectiveness of supervised physical therapy with unsupervised exercise for patients with LSS.
Methods: Patients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI), were enrolled from September 2014 to May 2018. Patients were randomized to a physical therapy group (PT group), which performed supervised physical therapy twice a week for 6 weeks or a home exercise group (HE group) using covariate adaptive randomization and online statistical computing web programming. Physical therapy sessions included manual therapy, stretching and strengthening exercises, cycling, and body weight-supported treadmill walking. All patients were asked to undertake a home exercise program. Patients in the HE group visited a physical therapist to confirm whether they performed home exercise once a week for 6 weeks. The primary outcome was the difference in improvement in symptom severity scores on the Zurich Claudication Questionnaire (ZCQ) at 6 weeks. Secondary outcomes included: physical function and satisfaction on the ZCQ; self-paced walking test (SPWT) performance; pain indicated using a numerical rating scale; and scores on the 36-Item Short-Form Survey (SF-36), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia. Compliance with the home exercise program was measured using a pedometer and self-report questionnaire. Scores and mean changes after 6 weeks were compared between the groups. A P-value 0.05 was considered significant.
Results: Forty-two patients (20 men and 22 women, average age 72.1 years) were allocated to the PT group and 42 patients (19 men and 23 women, average age 73.0 years) to the HE group. At baseline, there were no significant differences in age, gender, body mass index, duration of symptoms, MRI findings and the outcome measures between groups (P>0.05). At 6 weeks, compared with the HE group, the PT group showed significant improvements in ZCQ symptom severity (mean difference -0.4; 95% confidence interval [CI]: -0.6 to -0.2, P = 0.001), ZCQ physical function (mean difference -0.4; 95% CI: -0.6 to -0.2, P 0.001), walking distance on the SPWT (mean difference 473 m; 95% CI: 318 to 628, P 0.001), physical functioning (mean difference 9.4; 95% CI: 2.2 to 16.6, P = 0.011) and bodily pain (mean difference 10.6; 95% CI: 3.5 to 17.8, P = 0.004) on the SF-36, and number of daily steps (mean difference 741 steps/day; 95% CI: 199 to 1284, P = 0.008).
Conclusion(s): Supervised physical therapy for patients with LSS produced significant short-term improvements in pain, walking distance, disability, and physical activity compared with unsupervised exercise. Future studies should focus on long-term outcomes and surgery rates after exercise programs.
Implications: Patients with LSS should be treated with physical therapist interventions including supervised and intensive exercise than home exercise alone.
Keywords: lumbar spinal stenosis, neurogenic claudication, supervised exercise
Funding acknowledgements: We have no funding in this study.
Purpose: The purpose of this study was to compare the effectiveness of supervised physical therapy with unsupervised exercise for patients with LSS.
Methods: Patients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging (MRI), were enrolled from September 2014 to May 2018. Patients were randomized to a physical therapy group (PT group), which performed supervised physical therapy twice a week for 6 weeks or a home exercise group (HE group) using covariate adaptive randomization and online statistical computing web programming. Physical therapy sessions included manual therapy, stretching and strengthening exercises, cycling, and body weight-supported treadmill walking. All patients were asked to undertake a home exercise program. Patients in the HE group visited a physical therapist to confirm whether they performed home exercise once a week for 6 weeks. The primary outcome was the difference in improvement in symptom severity scores on the Zurich Claudication Questionnaire (ZCQ) at 6 weeks. Secondary outcomes included: physical function and satisfaction on the ZCQ; self-paced walking test (SPWT) performance; pain indicated using a numerical rating scale; and scores on the 36-Item Short-Form Survey (SF-36), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia. Compliance with the home exercise program was measured using a pedometer and self-report questionnaire. Scores and mean changes after 6 weeks were compared between the groups. A P-value 0.05 was considered significant.
Results: Forty-two patients (20 men and 22 women, average age 72.1 years) were allocated to the PT group and 42 patients (19 men and 23 women, average age 73.0 years) to the HE group. At baseline, there were no significant differences in age, gender, body mass index, duration of symptoms, MRI findings and the outcome measures between groups (P>0.05). At 6 weeks, compared with the HE group, the PT group showed significant improvements in ZCQ symptom severity (mean difference -0.4; 95% confidence interval [CI]: -0.6 to -0.2, P = 0.001), ZCQ physical function (mean difference -0.4; 95% CI: -0.6 to -0.2, P 0.001), walking distance on the SPWT (mean difference 473 m; 95% CI: 318 to 628, P 0.001), physical functioning (mean difference 9.4; 95% CI: 2.2 to 16.6, P = 0.011) and bodily pain (mean difference 10.6; 95% CI: 3.5 to 17.8, P = 0.004) on the SF-36, and number of daily steps (mean difference 741 steps/day; 95% CI: 199 to 1284, P = 0.008).
Conclusion(s): Supervised physical therapy for patients with LSS produced significant short-term improvements in pain, walking distance, disability, and physical activity compared with unsupervised exercise. Future studies should focus on long-term outcomes and surgery rates after exercise programs.
Implications: Patients with LSS should be treated with physical therapist interventions including supervised and intensive exercise than home exercise alone.
Keywords: lumbar spinal stenosis, neurogenic claudication, supervised exercise
Funding acknowledgements: We have no funding in this study.
Topic: Musculoskeletal: spine; Older people; Pain & pain management
Ethics approval required: Yes
Institution: Wakayama Medical University
Ethics committee: Institutional Review Board of Wakayama Medical University
Ethics number: 1426
All authors, affiliations and abstracts have been published as submitted.
