The Use Of Computerized Activity Monitors To Assess Changes In Community Participation After Epidural Steroid Injections For Lumbar Spinal Stenosis

Abstract

PURPOSE: Walking limitation associated with neurogenic claudication is a hallmark of disability in lumbar spinal stenosis (LSS). Capacity and performance have been defined as two distinct aspects of disability. Research suggests that epidural steroid injections may reduce claudication symptoms and thereby improve walking capacity over the short term in people with LSS. However, it is not known whether this translates to increased participation in the community. Computerized activity monitors allow us to examine this concept. The purpose of this study was to examine changes in community participation following steroid injections for LSS, using activity monitors. METHODS: Individuals with LSS confirmed on imaging who were having an epidural steroid injection for symptomatic LSS participated. One week prior to injection and two weeks post-injection, subjects performed a self-paced walking test (SPWT) of up to 30 minutes and filled out questionnaires. Subjects wore an Actigraph activity monitor during waking hours for the 7 days prior to injection and day 7-14 post-injection. Community participation was assessed with activity counts and steps per day. RESULTS: Subjects (n=12) had a mean age of 66.3±9.8 years and were 67% male; All reported symptoms of neurogenic claudication with walking. Both participation indices (activity counts and steps per day) showed a non-significant trend toward improvement post-injection. Daily activity counts improved from 640008±530808 to 718377±504246, while steps per day increased from 2718±2096 to 2891±2016. Non-significant improvements were also observed in leg pain, back pain, Oswestry Disability Index, SPWT, Physical Function Scale of the Stucki Questionnaire and SF-36 Quality of Life. Changes in activity counts (participation) were significantly (p<0.05) related to changes in leg pain (r=0.77), quality of life (r=0.78) and walking capacity (SPWT) (r=0.61). In order to increase power to detect changes, subject recruitment continues. CONCLUSION: Community participation measured with activity monitors increased slightly post-epidural steroid injection in patients with symptomatic LSS. This short term change in activity level was related to reductions in leg pain, increased walking capacity and improved quality of life.