Physical therapy may help patients with lumbar stenosis avoid surgery

Patients with lumbar spinal stenosis can reduce their chances of surgery within one year if they perform physical therapy, according to researchers who analyzed data from the Spine Patient Outcomes Research Trial (SPORT) to look at the association between physical therapy and long-term outcomes in these individuals.

“Receiving physical therapy was associated with greater improvement in physical functioning, a reduced likelihood of receiving surgery, and a higher likelihood of a patient self-rating of major improvement over a 1-year follow-up period. The percentage of patients receiving surgery was 12% lower, and the percentage noting major improvement was 16% higher after 1 year among patients receiving physical therapy,” Julie M. Fritz, PhD, PT, ATC, and colleagues wrote in the study.

They analyzed data from the multicenter SPORT study, which had a randomized and a concurrent observational cohort of patients with lumbar spinal stenosis. Investigators used identical inclusion criteria and assessments for both cohorts, according to the study details.

Initial analyses compared baseline characteristics of patients in the conservative cohort who did or did not receive physical therapy as an initial management approach during the first 6 weeks after enrollment, according to information in the study. Baseline factors associated with receiving physical therapy during the first 6 weeks were examined using stepwise logistic regression.

Of 297 patients in the conservative care cohort, there were complete data concerning physical therapy utilization for 244 patients (82%) at the 6-week follow-up.

Fritz and colleagues noted there were few baseline differences between patients who did or did not receive physical therapy in the first 6 weeks, however they found the group that did not receive physical therapy was more likely to experience radiating pain that extended below the knee at baseline (P=0.005). These patients were also more likely to prefer surgical treatment.

Fritz and colleagues also found an association between receiving physical therapy in the early time period they looked at and a patient’s tendency to rate their overall improvement and physical function as being better with time.

Furthermore, based on the results, patients who underwent early physical therapy had a reduced likelihood of undergoing surgery during the 1-year follow-up, although other outcomes did not differ between the groups that received or did not receive physical therapy.

“The results of this analysis emphasize the need for further research to define the most effective conservative management strategies for patients with lumbar spinal stenosis,” Fritz and colleagues wrote. – by Robert Linnehan

Disclosures: Fritz is on the scientific advisory board/other office for FOTO, Inc. Jon D. Lurie’s institution received grants from the NIH and AHRQ, he has stock ownership in NewVert, is a consultant to FzioMed, NewVert, FIMDM, Blue Cross Blue Shield and Baxano. Wenyan Zhao’s institution received a grant from NIH/NIAMS. Julie M. Whitman has no relevant financial disclosures. Anthony Delitto has speaking and/or teaching arrangements with APTA and received grants from the NIH. Gerard P. Brennan has no relevant financial disclosures. James N. Weintein’s institution received a grant from NIH/NIAMS.

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Source:

Fritz JM. Spine J. 2013. DOI: 10.1016/j.spinee.2013.09.044.