PMID- 29935152
OWN - NLM
STAT- MEDLINE
DCOM- 20190715
LR  - 20190715
IS  - 1532-821X (Electronic)
IS  - 0003-9993 (Linking)
VI  - 99
IP  - 12
DP  - 2018 Dec
TI  - Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking 
      Ability in Lumbar Spinal Stenosis: A Randomized Trial.
PG  - 2408-2419.e2
LID - S0003-9993(18)30362-9 [pii]
LID - 10.1016/j.apmr.2018.05.014 [doi]
AB  - OBJECTIVES: To compare the effectiveness of a comprehensive nonsurgical training 
      program to a self-directed approach in improving walking ability in lumbar spinal 
      stenosis (LSS). DESIGN: Randomized controlled trial. SETTING: Academic hospital 
      outpatient clinic. PARTICIPANTS: Participants (N=104) with neurogenic 
      claudication and imaging confirmed LSS were randomized. The mean age was 70.6 
      years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum 
      walking capacity was 328.7 m. INTERVENTIONS: A 6-week structured comprehensive 
      training program or a 6-week self-directed program. MAIN OUTCOME MEASURES: 
      Continuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) 
      and proportion of participants achieving at least 30% improvement (minimally 
      clinically important difference [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 
      subscales. RESULTS: A total of 48 versus 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 421.0 
      m (95% confidence interval [95% CI], 181.4-660.6), 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, 1.3; 95% CI, 
      1.0-1.7; P=.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, Medical Outcomes Study 36-Item Short-Form Health Survey-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 
      nonsurgical treatment option for patients with neurogenic claudication due to 
      LSS.
CI  - Copyright (c) 2018 American Congress of Rehabilitation Medicine. Published by 
      Elsevier Inc. All rights reserved.
FAU - Ammendolia, Carlo
AU  - Ammendolia C
AD  - Institute of Health Policy, Management and Evaluation, University of Toronto, 
      Toronto, Ontario, Canada; Rebecca MacDonald Centre for Arthritis & Autoimmune 
      Disease, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: 
      cammendolia@mtsinai.on.ca.
FAU - Cote, Pierre
AU  - Cote P
AD  - Institute of Health Policy, Management and Evaluation, University of Toronto, 
      Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of 
      Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, University of 
      Ontario Institute of Technology and UOIT-CMCC Centre for Disability Prevention 
      and Rehabilitation, Toronto, Ontario, Canada.
FAU - Southerst, Danielle
AU  - Southerst D
AD  - Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic 
      Surgery, NYU Langone Health, New York, NY.
FAU - Schneider, Michael
AU  - Schneider M
AD  - Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
FAU - Budgell, Brian
AU  - Budgell B
AD  - Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
FAU - Bombardier, Claire
AU  - Bombardier C
AD  - Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, 
      Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, 
      Canada.
FAU - Hawker, Gillian
AU  - Hawker G
AD  - Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, 
      Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, 
      Canada.
FAU - Rampersaud, Y Raja
AU  - Rampersaud YR
AD  - Department of Orthopedics, Toronto Western Hospital, University Health Network, 
      Toronto, Ontario, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT02592642
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20180620
PL  - United States
TA  - Arch Phys Med Rehabil
JT  - Archives of physical medicine and rehabilitation
JID - 2985158R
SB  - IM
CIN - J Physiother. 2019 Jul;65(3):174. PMID: 31101520
CIN - J Physiother. 2019 Jul;65(3):174. PMID: 31101524
MH  - Aged
MH  - Comprehensive Health Care/*methods
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - *Lumbar Vertebrae
MH  - Male
MH  - Minimal Clinically Important Difference
MH  - Self Care/*methods
MH  - Single-Blind Method
MH  - Spinal Stenosis/physiopathology/*therapy
MH  - Walk Test
MH  - *Walking
OTO - NOTNLM
OT  - Back
OT  - Conservative treatment
OT  - Randomized controlled trial
OT  - Rehabilitation
OT  - Spinal stenosis
EDAT- 2018/06/24 06:00
MHDA- 2019/07/16 06:00
CRDT- 2018/06/24 06:00
PHST- 2018/01/16 00:00 [received]
PHST- 2018/05/08 00:00 [revised]
PHST- 2018/05/11 00:00 [accepted]
PHST- 2018/06/24 06:00 [pubmed]
PHST- 2019/07/16 06:00 [medline]
PHST- 2018/06/24 06:00 [entrez]
AID - S0003-9993(18)30362-9 [pii]
AID - 10.1016/j.apmr.2018.05.014 [doi]
PST - ppublish
SO  - Arch Phys Med Rehabil. 2018 Dec;99(12):2408-2419.e2. doi: 
      10.1016/j.apmr.2018.05.014. Epub 2018 Jun 20.