Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial

Abstract

BACKGROUND CONTEXTExercise has been reported to improve short-term outcomes for patients with LSS in terms of disability and back and leg pain. However, no studies have compared supervised exercise with unsupervised exercise or quantified physical activity using a pedometer to confirm compliance with a home exercise program. PURPOSETo compare the effectiveness of supervised physical therapy (PT) with unsupervised exercise for patients with lumbar spinal stenosis (LSS). STUDY DESIGN/SETTINGA single-center, open-label, randomized controlled trial. PATIENT SAMPLEPatients presenting with symptoms of neurogenic claudication caused by LSS, which was confirmed by magnetic resonance imaging. OUTCOME MEASURESThe primary outcome was improvement in symptom severity scores on the Zurich Claudication Questionnaire (ZCQ) at 6 weeks. Secondary outcomes included physical function on the ZCQ, self-paced walking test (SPWT) performance, pain indicated using a numerical rating scale (NRS), and the number of daily steps measured by pedometer. METHODSPatients with LSS were randomized to a PT group, who performed supervised PT twice a week for 6 weeks, or a home exercise (HE) group. PT sessions included manual therapy, individually tailored stretching and strengthening exercises, cycling, and body weight-supported treadmill walking. RESULTSForty-three patients were randomly allocated to the PT group and 43 patients to the HE group. Compared with the HE group, the PT group had greater percentage of responders achieving minimum clinically important difference in ZCQ symptom severity (difference for percentage between groups [95%confidence interval], 30.2% [9.1–48.6], p=.01), ZCQ physical function (32.6% [11.6–50.6], p<.01), walking distance on the SPWT (39.5% [18.8–56.7], p<.01), leg pain on the NRS (34.9% [13.9–52.7], p<.01), and number of daily steps (25.6% [4.9–43.9], p=.01). CONCLUSIONSSupervised PT for patients with LSS resulted in significant short-term improvements in symptom severity, physical function, walking distance, pain, and physical activity compared with unsupervised exercise.