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A Comparison Between Two Physical Therapy Treatment Programs for Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial

Whitman, Julie M., DSc, PT*; Flynn, Timothy W., PhD, PT*; Childs, John D., PhD, PT, MBA; Wainner, Robert S., PhD, PT§; Gill, Howard E., MD; Ryder, Michael G., DSc, PT; Garber, Matthew B., DSc, PT; Bennett, Andrew C., DPT; Fritz, Julie M., PhD, PT**

doi: 10.1097/01.brs.0000241136.98159.8c
Randomized Trial

Study Design. Multicenter randomized, controlled trial.

Objective. To compare two physical therapy programs for patients with lumbar spinal stenosis.

Summary of Background Data. Scant evidence exists regarding effectiveness of nonsurgical management programs for lumbar spinal stenosis.

Methods. Fifty-eight patients with lumbar spinal stenosis were randomized to one of two 6-week physical therapy programs. One program included manual physical therapy, body weight supported treadmill walking, and exercise (Manual Physical Therapy, Exercise, and Walking Group), while the other included lumbar flexion exercises, a treadmill walking program, and subtherapeutic ultrasound (Flexion Exercise and Walking Group). Perceived recovery was assessed with a global rating of change scale. Secondary outcomes included: Oswestry, a numerical pain rating scale, a measure of satisfaction, and a treadmill test. Testing occurred at baseline, 6 weeks, and 1 year. Perceived recovery, pain, and other healthcare resources used were collected with a long-term follow-up questionnaire.

Results. A greater proportion of patients in the manual physical therapy, exercise, and walking group reported recovery at 6 weeks compared with the flexion exercise and walking group (P = 0.0015), with a number needed to treat for perceived recovery of 2.6 (confidence interval, 1.8–7.8). At 1 year, 62% and 41% of the manual therapy, exercise, and walking group and the flexion exercise and walking group, respectively, still met the threshold for recovery. Improvements in disability, satisfaction, and treadmill walking tests favored the manual physical therapy, exercise, and walking group at all follow-up points.

Conclusions. Patients with lumbar spinal stenosis can benefit from physical therapy. Additional gains may be realized with the inclusion of manual physical therapy interventions, exercise, and a progressive body-weight supported treadmill walking program.

Physical therapy can be beneficial for patients with spinal stenosis. A program including manual physical therapy, exercise, and body-weight supported treadmill training may yield additional improvements in clinically important outcomes beyond those achieved with a program including lumbar flexion exercises and level treadmill training.

From the *Regis University, Denver, CO; †U.S. Army-Baylor Doctoral Program in Physical Therapy, San Antonio, TX; ‡Texas Physical Therapy Specialists, New Braunfels, TX; §Southwest Texas State University, San Marcos, TX; ∥Wilford Hall Medical Center, San Antonio, TX; ¶Brooke Army Medical Center, Ft. Sam Houston, TX; and **University of Utah and Intermountain Health Care, Salt Lake City, UT. Trial Registry: ISRCTN74263096. Current Controlled Trials Ltd., Middlesex Hwse, 34-42 Cleveland Street, London W1T 4LB UK.

Acknowledgment date: November 1, 2005. First revision date: December 29, 2005. Acceptance date: January 11, 2006.

Supported by the Orthopaedic Section of the American Physical Therapy Association and the U.S. Air Force Office of the Surgeon's General. These agencies played no role in the design, conduct, reporting, or decision to submit this manuscript for publication.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force, the U.S. Army, or the U.S. Department of Defense.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Julie M. Whitman, DSc, PT, RHSHP-Department of Physical Therapy, Regis University, 3333 Regis Blvd., G-4, Denver, CO 80221-1099; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.