Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program

Young, James J.; Kongsted, Alice; Hartvigsen, Jan; Roos, Ewa M.; Ammendolia, Carlo; Skou, Søren Thorgaard; Grønne, D.T.; Jensen, Rikke Krüger

doi:10.1016/j.ocarto.2022.100324

Cited by 5 publications

(5 citation statements)

References 47 publications

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“…Confirmation of our results using the alternate age cut-point increases confidence in our findings. We were unable to include imaging confirmation of LSS since this is not collected in GLA:D® Back, but our approach is sufficient for preliminary estimates in this field [ 17 , 18 ], considering LSS is a clinical diagnosis [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program

Young,

Kongsted,

Hartvigsen

et al. 2023

BMC Musculoskelet Disord

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Background People with nonspecific low back pain (NSLBP) can also experience overlapping symptoms of lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. This study investigated differences in treatment outcomes for disability, back pain intensity, and leg pain intensity following an education and exercise therapy program for NSLBP patients with and without comorbid LSS symptoms. Methods This was a longitudinal analysis of 655 Danish participants in the GLA:D® Back program; an education and exercise therapy program for people with persistent NSLBP. Participants were classified as having comorbid LSS symptoms based on self-report. Linear mixed models were used to assess differences in change in disability (Oswestry Disability Index [0-100]) and back and leg pain intensity (Numeric Rating Scale [0–10]) at 3-, 6-, and 12-months between those with and without LSS symptoms. Results 28% of participants reported LSS symptoms. No certain differences in change in disability or back pain intensity improvement were observed at any time-point between those with and without LSS symptoms. Participants with LSS symptoms had slightly greater improvement in leg pain intensity at 6- (-0.7, 95% CI -1.2 to -0.2) and 12-months (-0.6, 95% CI -1.2 to -0.1). Conclusion Compared to those without LSS symptoms, patients with persistent NSLBP and LSS symptoms can expect similar improvements in disability and back pain intensity, and slightly greater improvements in leg pain intensity with treatment. Therefore, education and exercise therapy programs designed for NSLBP are likely helpful for those also experiencing LSS symptoms.

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Section: Discussionmentioning

confidence: 99%

Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program

Young,

Kongsted,

Hartvigsen

et al. 2023

BMC Musculoskelet Disord

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“…As there are no consensus diagnostic criteria for LSS [ 13 , 24 – 26 ], these items were selected based on their common usage in diagnostic questionnaires and utility in identifying LSS-related leg pain from other sources of leg pain such as radiculopathy from lumbar disc herniation [ 27 , 28 ]. Similar LSS definitions have been used in recent LSS clinical and epidemiological studies [ 21 , 29 , 30 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, no included study investigated if people with co-occurring LSS and knee or hip OA have a different clinical presentation than those with these conditions in isolation, despite considerable overlap in the clinical presentations of LSS and knee and hip OA [ 11 – 14 ]. Since previous studies have shown comorbid LSS and other degenerative disorders of the lumbar spine affect OA treatment outcomes [ 15 – 21 ], a better understanding of the clinical presentation for co-occurring LSS with knee or hip OA can help inform clinical reasoning and shared-decision making when selecting management strategies, including potential prognostic significance.…”

Section: Introductionmentioning

confidence: 99%

Characteristics associated with comorbid lumbar spinal stenosis symptoms in people with knee or hip osteoarthritis: an analysis of 9,136 good life with osteoArthritis in Denmark (GLA:D®) participants

Young

Kongsted

Jensen

et al. 2023

BMC Musculoskelet Disord

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Background Previous studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this cross-sectional study was to explore characteristics associated with comorbid symptoms of lumbar spinal stenosis (LSS) in people with knee or hip osteoarthritis (OA) enrolled in a primary care education and exercise program. Methods Sociodemographic, clinical characteristics, health status measures, and a self-report questionnaire on the presence of LSS symptoms was collected at baseline from the Good Life with osteoArthritis in Denmark primary care program for knee and hip OA. Cross-sectional associations between characteristics and the presence of comorbid LSS symptoms were assessed separately in participants with primary complaint of knee and hip OA, using domain-specific logistic models and a logistic model including all characteristics. Results A total of 6,541 participants with a primary complaint of knee OA and 2,595 participants with a primary complaint of hip OA were included, of which 40% and 50% reported comorbid LSS symptoms, respectively. LSS symptoms were associated with similar characteristics in knee and hip OA. Sick leave was the only sociodemographic variable consistently associated with LSS symptoms. For clinical characteristics, back pain, longer symptom duration and bilateral or comorbid knee or hip symptoms were also consistently associated. Health status measures were not consistently related to LSS symptoms. Conclusion Comorbid LSS symptoms in people with knee or hip OA undergoing a primary care treatment program of group-based education and exercise were common and associated with a similar set of characteristics. These characteristics may help to identify people with co-occurring LSS and knee or hip OA, which can be used to help guide clinical decision-making.

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“…This exacerbates pain and disability compared to those without comorbidities [ 92 ]. RCTs and observational studies suggest that exercise therapy improves health outcomes in people with OA and comorbidities [ 90 , 93 – 96 ]. As an example, people with OA and type 2 diabetes mellitus improved to the same extent as people with OA and heart failure [ 94 ].…”

Section: Are the Benefits Of Exercise Therapy Greater Than Just For Oa?mentioning

confidence: 99%

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Young

Pedersen

2023

Curr Treat Options in Rheum

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Purpose of review Exercise therapy is the first line treatment for patients with knee and hip osteoarthritis (OA) but is consistently underutilized. In this review, we aim to provide health care professionals with an overview of the latest evidence in the areas of exercise therapy for OA, which can serve as a guide for incorporating the ideal exercise therapy prescription in the overall management plan for their patients with OA. Recent findings Evidence continues to be produced supporting the use of exercise therapy for all patients with knee or hip OA. Ample evidence exists suggesting exercise therapy is a safe form of treatment, for both joint structures and the patient overall. Several systematic reviews show that exercise therapy is likely to improve patient outcomes, regardless of disease severity or comorbidities. However, no single type of exercise therapy is superior to others. Summary Health care practitioners and patients should be encouraged to incorporate exercise therapy into treatment plans and can be assured of the safety profile and likelihood of improvement in important patient outcomes. Since no single exercise therapy program shows vastly superior benefit, patient preference and contextual factors should be central to the shared decision-making process when selecting and individualising appropriate exercise therapy prescriptions.

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Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program

Cited by 5 publications

References 47 publications

Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program

Similar improvements in patient-reported outcomes for non-specific low back pain patients with and without lumbar spinal stenosis symptoms following a structured education and exercise therapy program

Characteristics associated with comorbid lumbar spinal stenosis symptoms in people with knee or hip osteoarthritis: an analysis of 9,136 good life with osteoArthritis in Denmark (GLA:D®) participants

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

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