Comprehensive non-surgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial

Publication date: Available online 20 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Carlo Ammendolia, Pierre Côté, Danielle Southerst, Michael Schneider, Brian Budgell, Claire Bombardier, Gillian Hawker, Y. Raja Rampersaud
ObjectivesTo compare the effectiveness of a comprehensive non-surgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis.DesignRandomized controlled trial.SettingAcademic hospital outpatient clinic.ParticipantsA 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.InterventionsA six-week structured comprehensive training program or a six-week self-directed program.Main Outcome MeasuresContinuous 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.ResultsForty-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.ConclusionsA 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.



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