Effect of a Multimodal Movement Intervention in Patients With Neurogenic Claudication Based on Lumbar Spinal Stenosis and/or Degenerative Spondylolisthesis-A Pilot Study.

Kim-Charline Broscheid,Katharina Meiler,Tabea Gagelmann,Lutz Schega,Jörg Franke,Christina Caspari,Christian Schmidt,Tom Behrendt,Andre Napiontek,Dennis Hamacher,Svantje Böker

doi:10.3389/fmed.2020.540070

Kim-Charline Broscheid, Katharina Meiler + Show 9 more

Open Access

https://doi.org/10.3389/fmed.2020.540070

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Abstract

Chronic low-back pain is a major individual, social, and economic burden. The impairment ranges from deterioration of gait, limited mobility, to psychosocial distress. Due to this complexity, the demand for multimodal treatments is huge. Our purpose is to compare the effects of a multimodal movement intervention (MI) (coordinative–cognitive exercises and dancing program) with standard physical therapy (PT) on gait, physical function, and quality of life in patients with lumbar spinal stenosis (LSS). The study design is based on a 6-week intervention with a two (group: MI/PT) by two (measurement time points: pre-/post-test) parallel group design with random assignment. Twenty-four subjects (18 female/6 male, 70.8 ± 10.6 years old) diagnosed with LSS were included and randomly allocated to the MI or PT group. The primary outcomes are minimum toe clearance (MTC) and double step length (DSL) variability and the Timed “Up & Go” test (TUG). Secondary outcomes are the Brief Pain Inventory, the short Fall Efficacy Scale–International (sFES-I), and the Oswestry Disability Index. Nine subjects for each group could be analyzed. The MTC variability revealed a significant between-group difference in the posttest (p = 0.008) showing a lower MTC variability for the MI compared to the PT group. The MI group displayed an improved TUG (p = 0.031) and a reduced sFES-I (p = 0.044). The decreased MTC variability and fear of falling as well as the improved functional mobility may contribute to a reduced risk of falling. For the subsequent study, further kinematic and cognitive parameters should be analyzed, and the number of participants has to be increased.Clinical Trial Registration: German Clinical Trial Register (ID: DRKS00021026/URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021026).

Highlights

Over 500 million people worldwide suffer from low-back pain (LBP) and the associated health restrictions, regardless of gender, or economic status [1, 2]
Related to chronic LBP are degenerative changes resulting in spondylolisthesis and lumbar spinal stenosis (LSS) contributing to neurogenic claudication [5, 6]
The objective of this study is to evaluate the beneficial effects of a multimodal intervention (MI) composed of a coordinative–cognitive training and a dancing program in contrast to standard physical therapy (PT) on the risk of falling in patients with chronic LBP, neurogenic claudication in LSS and/or degenerative spondylolisthesis

Summary

Introduction

Over 500 million people worldwide suffer from low-back pain (LBP) and the associated health restrictions, regardless of gender, or economic status [1, 2]. The pain is often accompanied by insufficient muscular stabilization and poor posture [9, 10] All these factors lead to a change in gait pattern [11, 12], which lead to an increased risk of falling. Several studies indicate that people with chronic LBP have a higher prevalence of falls than people of comparable ages [13,14,15]. This can lead to severe health consequences [16] and is a personal, social, and economic burden

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