Background/Purpose: Degenerative lumbar spinal stenosis (DLSS) is a leading cause of pain, disability and loss of independence in older adults. It is caused by age related osteoarthritic changes to the lumbar spine resulting in spinal canal narrowing and compression to the spinal nerves. Neurogenic claudication is the clinical syndrome caused by DLSS and reduced walking ability is its hallmark feature. Effective non-surgical approaches for DLSS are unknown. The main objective of this study is to compare the ability of 2 self-management training programs to improve walking capacity in DLSS.

Methods: Eligible consenting participants with neurogenic claudication with DLSS and limited walking ability (<30 minutes) were randomized to a 6-week (w) comprehensive self-management training program or a self-directed self-management training program with a single educational session. Both groups received a pedometer, an exercise manual and video with instructions on daily home exercises and self-management strategies recommended to be followed for life. The primary outcomes were objective continuous walking distance in meters (m) in 30 minutes assessed by the Self-Paced Walk Test (SPWT) at 8w, 3, 6 and 12 months following randomization; and the proportion of participants achieving at least 30% improvement (minimal clinically important difference, MCID) in the SPWT. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), the Oswestry Disability Index and the Numeric Pain Scale for low back and leg pain. Intention-to-treat analysis was performed for all outcomes.

Results: Fifty-one participants were randomized to the comprehensive and 53 to the self-directed group. At 8w, the mean improvement in walking distance was 502m in the comprehensive group and 211m in the self-directed group, with an adjusted mean treatment effect of 345.4m; 95% confidence interval [CI], 150 to 660.6; P=0.0006. At 12 months the mean improvement in walking distance from baseline was 675m in the comprehensive group and 201m in the self-directed group with a between-group adjusted mean difference of 473.2m; 95% CI, 203.9 to 742.4; P = 0.0007. At 8w, 85% verses 61%, adjusted relative risk (RR), 1.4; 95% CI, 1.1 to 1.8; P= 0.008, and at 12 months, 81% verses 59%, adjusted RR, 1.4; 95% CI, 1.1 to 1.8; P= 0.018, of participants achieved the MCID in the SPWT in the comprehensive verses the self-directed group respectively. At 12 months all secondary outcomes showed significant improvement from baseline in both groups with the comprehensive group demonstrating significantly greater improvement in the ZCQ functional scale, adjusted mean difference of -0.27; 95% CI, -0.49 to -0.04, and in the combined functional and symptom ZCQ scale, adjusted mean difference of -0.48; 95% CI, -0.90 to -0.06 compared to the self-directed group.

Conclusion: Both self-management training programs showed significant improvement in walking distance with the comprehensive program demonstrating superior improvement in walking distance and proportion of participants meeting the MCID at each follow-up. The large improvement in walking distance in comprehensive group was sustained at 12 months without additional interventions beyond the initial comprehensive training program.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-walking-ability-in-degenerative-lumbar-spinal-stenosis-a-randomized-trial-comparing-2-self-management-training-programs/