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Titre : | Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial (2018) |
Auteurs : | Carlo Ammendolia ; Pierre Côté ; Danielle Southerst |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 99, n° 12, 2018) |
Article en page(s) : | p. 2408-2419 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Dos ; Rééducation et réadaptation |
Mots-clés: | Back ; Conservative treatment ; Traitement conservateur ; Randomized controlled trial ; Essai contrôlé randomisé ; Spinal stenosis ; Sténose du canal vertébral |
Résumé : |
Objectives To compare the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis (LSS). Design Randomized controlled trial. Setting Academic hospital outpatient clinic. Participants Participants (N=104) with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum walking capacity was 328.7 m. Interventions A 6-week structured comprehensive training program or a 6-week self-directed program. Main Outcome Measures Continuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (minimally clinically important difference [MCID]) in the SPWT at 6 months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score, and the Short-Form General Health Survey subscales. Results A total of 48 versus 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment, respectively, received the intervention and 89% of the total study sample completed the study. At 6 months, the adjusted mean difference in walking distance from baseline was 421.0 m (95% confidence interval [95% CI], 181.4-660.6), favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID (adjusted relative risk, 1.3; 95% CI, 1.0-1.7; P=.03). Both primary treatment effects persisted at 12 months favoring the comprehensive program. At 6 months, the ODI walk score and at 12 months the ZCQ, Medical Outcomes Study 36-Item Short-Form Health Survey-physical function and -bodily pain scores showed greater improvements favoring the comprehensive program. Conclusions A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999318303629 |