Publication date: Available online 29 January 2019
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Amy Hammerich, Julie Whitman, Paul Mintkin, Thomas Denninger, Venu Akuthota, Eric E. Sawyer, Melissa Hofmann, John D. Childs, Joshua Cleland
Abstract
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in patients with lumbar spinal stenosis (LSS).
Design
Randomized clinical trial.
Setting
Orthopaedic spine clinics.
Participants
390 patients were screened with 60 eligible and randomly selected to receive ESI and education with or without PT.
Interventions
54 patients received 1-3 injections and education in a 10 week intervention period with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multi-modal PT (ESI+PT).
Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.
Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point although the sample had significant improvements at 10 weeks (p < .001; 95% CI: -18.01, -5.51) and 1 year (p = .01; 95% CI: -14.57, -2.03) above MCID. Significant differences in SF36 were found for ESI+PT at 10 weeks with higher emotional role function (p = .03; 95% CI: -49.05, -8.01), emotional well-being (p = .02; 95% CI:-19.52, 2.99), and general health perception (p = .05; 95% CI: -17.20, -.78).
Conclusions
ESI plus PT was not superior to ESI alone for reducing disability in people with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health.
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