A Criterion Measure of Walking Capacity in Lumbar Spinal Stenosis and Its Comparison With a Treadmill Protocol

Tomkins, Christy C.; Battié, Michele C.; Rogers, Thomas D.; Jiang, Haochuan; Petersen, Stewart R.

doi:10.1097/brs.0b013e3181b03fc8

Cited by 82 publications

(77 citation statements)

References 30 publications

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“…The primary performance-based outcome measure will be the Self-Paced Walk Test (SPWT), which is a validated measure of walking capacity in patients with LSS [20]. This test involves having the patient walk comfortably at his/her own pace on a level surface until s/he must rest due to symptoms of back or leg pain.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

et al. 2014

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BackgroundLumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis.Methods/designThis study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome.DiscussionOur study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms.Trial registrationClinicalTrials.gov identifier: NCT01943435

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Section: Methodsmentioning

confidence: 99%

“…Primary outcome measures of self-reported pain/function and physical performance are the Swiss Spinal Stenosis questionnaire [19] and the Self-Paced Walking Test [20]. Secondary outcome measure of physical activity is the SenseWear armband (BodyMedia, Pittsburgh, PA) worn for 1 week.…”

Section: Methodsmentioning

confidence: 99%

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

et al. 2014

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“…Tests used for this purpose include treadmill protocols, 31 49-55 the gait loading test, 56 and the self paced walking test. 55 Tests of lumbar extension loading have also been proposed for use in the diagnosis of LSS. 57 Researchers have also recently begun to assess the impact of LSS on daily physical activities and on gait characteristics using accelerometry.…”

Section: Natural Course Of Lssmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

390

310

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Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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“…Since LSS was first described by Verbiest [2], an important research focus has been on the evaluation of clinical, radiological, and other diagnostic criteria to better describe this condition [3][4][5][6][7][8][9]. One major problem is that imaging findings do not always correlate with clinical symptoms [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis

et al. 2014

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A Criterion Measure of Walking Capacity in Lumbar Spinal Stenosis and Its Comparison With a Treadmill Protocol

Cited by 82 publications

References 30 publications

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

Management of lumbar spinal stenosis

Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis

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