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Comer, Christine; Redmond, Anthony; Bird, Howard; Hensor, Elizabeth; Conaghan, Philip
University of Leeds, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Leeds, UK
INTRODUCTION: People with lumbar spinal stenosis commonly present with symptoms of neurogenic claudication and are often referred to physiotherapists for exercise treatment prior to surgical treatment. There is, however, a need for trials evidence to establish whether exercise treatment is beneficial.
METHODS: This randomised controlled trial compared a six week exercise programme to a control of advice only. The primary outcome was the Zurich Claudication Questionnaire (ZCQ) score at 8 weeks. ANCOVA analysis was undertaken using the score change as the dependent variable, and baseline values, age and sex as independent covariates. Secondary outcomes included levels of back and leg pain, measures of disability, anxiety and depression, and a shuttle walking test.
RESULTS: 76 participants with neurogenic claudication symptoms were recruited. Follow‐up data were available at 8 weeks for 36 control and 34 treatment group participants. Six patients withdrew because of illness, difficulties attending for treatment or because of a preference for different treatment. Participants in the exercise group attended for a median of 3 treatments (range 0 to 4). The ZCQ scores did not change significantly in either group, and there was no significant between‐group difference for either the ZCQ symptom severity scale score (0.05 points; P = 0.657) or the physical function score (0.11 points; P = 0.354). There was, however, a significantly greater improvement in walking distance in the exercise group compared to the control group at 8 week follow‐up (6.97 metres; P = 0.002) after exclusion of outlying data.
DISCUSSION: Although patients with neurogenic claudication symptoms are often prescribed exercises, these results indicate that a self‐directed programme of flexion and aerobic type exercises does not improve symptom severity or physical function despite small improvements in walking distance. Further analysis from the trial data will include 12 month follow‐up.
© 2011 Lippincott Williams & Wilkins, Inc.
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