None listed
Conditions
Brief summary
Lumbar spinal stenosis (LSS) with neurogenic claudication is common in older adults, characterised by leg pain, heaviness and weakness when standing and walking. LSS-related neurogenic claudication is caused by a narrowed spinal canal that compromises the spinal nerves. While many people undergo surgery for this, most manage their symptoms through non-surgical care. Interestingly, medical imaging often shows spinal narrowing even in people without symptoms. Research suggests factors including spinal movements, psychological distress, and cardiovasular health play an important role. Importantly, these factors can be modified with target conservative treatments. We have developed a personalised multimodal physiotherapy intervention, including patient education, lifestyle modification, specific exercises, manual therapy and cardiovascular exercises. This pilot study will explore potential effect of this approach in three patients with LSS-related neurogenic claudication. People who are interested in the study will complete an online eligibility survey. Potential participants will be invited to attend an initial physioptherapy assessment to confirm their eligibility and eligible participants will be enrolled in the study. Initially, participants will complete online pain questionnaire daily for one to two weeks to establish baseline. They will then attend seven weekly physiotherapy sessions delivered a trained physiotherapist and perform guided home exercises. Participants will record daily online pain questionnaires after completing the treatments for up to 6 weeks. Patients and physiotherapist will be interviewed to understand how the intervention is received and delivered. This study will provide pilot data for a future large study to conduct a full investigation of this new intervention.
Interventions
Derived from a biopsychosocial framework, treatments encompass psychologically informed patient education, lifestyle modification, neuropathic pain-specific exercises, manual therapy and exercise (e.g., stationary exercise bike) to improve general cardiovascular function. Based on initial physiotherapy assessment, participants will receive 7 weekly one-to-one physiotherapy sessions, tailored to individual clinical presentation. Patient education will included in each physiotherapy sessions as pa
Derived from a biopsychosocial framework, treatments encompass psychologically informed patient education, lifestyle modification, neuropathic pain-specific exercises, manual therapy and exercise (e.g., stationary exercise bike) to improve general cardiovascular function. Based on initial physiotherapy assessment, participants will receive 7 weekly one-to-one physiotherapy sessions, tailored to individual clinical presentation. Patient education will included in each physiotherapy sessions as part of the intervention (~10 minutes per visit, varying depending on participant's clinical presentation), inclduing a clear biopsychosocial explanation of their problem and outline of a comprehensive treatment plan, advice on avoiding excessive sedentary behaviour, activity/sporting technique modification, manual handling advice, strategies to address contributing factors related to sleep hygiene and lifestyle choices, and management of comorbidities if indicated. Participants will be prescribed a progressive general graded exercise programme matched to their clinical presentation. To unload neural tissue and optimise neural mechanics and load tolerance, physiotherapists will prescribe specific movement (e.g., mobility exercises targeting thoracic/hip extension) and muscle performance exercises (e.g., abdominal/hip extension muscle activation and strengthening exercises) tailored to each participant’s clinical presentation. Participants will be instructed to perform the prescribed exercises at home as frequently as needed to manage their pain. Exercise will be progressed as sensitivity of the affected nerves improves. When neural compromise is not evident, physiotherapists will provide manual therapy (e.g., passive joint mobilisation techniques to imporve lumbar flexion and thoracic/hip extension dysfunction, neural gliding and tensioning techniques) and exercises (e.g., neural gliding exercise) to optimise neural mechanics by directly mobilising the nerve. A qualified and registered physiotherapist who is trained in delivering this multimodal intervention will provide treatments for all participants. Each treatment session will last for 30 minutes whereas the initial consult will take 60 minutes. For home exercises, participants will be provided with written exercise instructions and diagrams and an exercise diary to monitor their adherence and any adverse events. Treatment attendance will be recorded to assess adherence to the intervention.
Sponsors
University of New South Wales
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
60 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
• people who have been diagnosed as having lumbar spinal stenosis (LSS) and share diagnostic imaging results (magnetic resonance imaging or computed tomography) showing narrowing of the central canal, lateral recess, and/or foramen • the presence of at least one of these clinical signs of LSS: (1) leg symptoms worsened by walking and relieved by sitting; (2) symptoms worsened by lumbar extension and relieved by flexion; and/or (3) leg pain relieved by leaning forward on a shopping cart while walking. • ability to read/write English • ability to walk outside without an assistive device • limitation of walking due to LSS • ability to engage in mild exercise
Exclusion criteria
• previous surgery for LSS or lumbar fusion • cauda equina symptoms • advised by a physician not to engage in physical exercise • history of metastatic cancer • severe peripheral artery disease • any neurologic disorders that affect the ability to walk • previous hip joint replacement including hemiarthroplasty • body mass index > 30 • osteoporosis
Outcome results
None listed