Supervised physical therapy versus unsupervised exercise for patients with lumbar spinal stenosis: 1-year follow-up of a randomized controlled trial

• Published in: Clinical rehabilitation Vol. 35; no. 7; p. 964
• Main Authors: Minetama, Masakazu, Kawakami, Mamoru, Teraguchi, Masatoshi, Kagotani, Ryohei, Mera, Yoshimasa, Sumiya, Tadashi, Nakagawa, Masafumi, Yamamoto, Yoshio, Matsuo, Sachika, Sakon, Nana, Nakatani, Tomohiro, Kitano, Tomoko, Nakagawa, Yukihiro
• Format: Journal Article
• Language: English
• Published: England 01.07.2021
• Subjects: Aged; Exercise Therapy; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Lumbar Vertebrae - physiopathology; Male; Minimal Clinically Important Difference; Orthopedic Procedures - statistics & numerical data; Pain Measurement; Physical Therapy Modalities; Quality of Life; Severity of Illness Index; Spinal Stenosis - physiopathology; Spinal Stenosis - rehabilitation; Exercise; lumbar spinal stenosis; surgery rate; Physical Therapy; intermittent claudication
• ISSN: 1477-0873
• DOI: 10.1177/0269215520986688

To compare the 1-year outcomes of patients with lumbar spinal stenosis treated with supervised physical therapy or unsupervised exercise. A single-center randomized controlled trial with concealed allocation, blinded assessor and intention-to-treat analysis. Spine care center. A total of 86 patients presenting with symptoms of neurogenic claudication caused by lumbar spinal stenosis. The physical therapy group received supervised physical therapy sessions twice a week for 6 weeks and home exercise program. The home exercise group received 6-week home exercise program only. The primary outcome was symptom severity on the Zurich claudication questionnaire at 1 year. Secondary outcomes included physical function, pain, health-related quality of life and the surgery rate after 1 year. At 1 year, more patients in the physical therapy group than in the home exercise group achieved minimum clinically important differences in Zurich claudication questionnaire symptom severity (60.5% vs 32.6%; adjusted odds ratio [AOR] 4.3, [95% CI [1.5-12.3],  = 0.01); Zurich claudication questionnaire physical function (55.8% vs 32.6%; AOR 3.0 [1.1-8.1],  = 0.03); SF-36 bodily pain (48.8% vs 25.6%; AOR 2.8 [1.1-7.3],  = 0.03), and SF-36 general health (20.9% vs 7.0%; AOR 6.1 [1.1-33.0],  = 0.04). The surgery rate at 1 year was lower in the physical therapy than in the home exercise group (7.0% vs 23.3%; AOR 0.2 [0.04-0.9]  = 0.04). Supervised physical therapy produced greater improvements in symptom severity and physical function than unsupervised exercise and was associated with lower likelihood of receiving surgery within 1 year.