Abstract
Tomkins-Lane CC, Conway J, Hepler C, Haig AJ. Changes in objectively measured physical
activity (performance) after epidural steroid injection for lumbar spinal stenosis.
Objective
To examine changes in objectively measured physical activity (performance) at 1 week
following epidural steroid injection for lumbar spinal stenosis.
Design
Prospective cohort.
Setting
University spine program.
Participants
Individuals (N=17) who were undergoing fluoroscopically guided epidural steroid injection
for symptomatic lumbar spinal stenosis (mean age ± SD, 70.1±6.7; 47% women).
Intervention
Fluoroscopically guided epidural injection.
Main Outcome Measure(s)
The 2 primary outcomes, measured with accelerometers, were total activity (performance)
measured over 7 days and maximum continuous activity (capacity). Walking capacity
was also assessed with the Self-Paced Walking Test, and subjects completed the Oswestry
Disability Index, Swiss Spinal Stenosis Questionnaire, Medical Outcomes Study 36-Item
Short-Form Health Survey, visual analog pain scales, and body diagrams.
Results
At 1 week postinjection, 58.8% of the subjects demonstrated increased total activity
and 53% had increased maximum continuous activity, although neither change was statistically
significant. Significant improvements were observed in a number of the self-report
instruments, including the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire,
general health (Medical Outcomes Study 36-Item Short-Form Health Survey), role-limitation
emotional (Medical Outcomes Study 36-Item Short-Form Health Survey), leg pain intensity
(visual analog pain scales), and presence of leg weakness.
Conclusions
While patients perceived improvements in pain and function following injection, these
improvements were not reflected in significant changes in performance or capacity.
Future studies will continue to find value in subjective measures of pain and quality
of life. However, with modern technology, performance is no longer a subjective variable.
Use of activity monitors to objectively measure performance can result in more rigorous
validation of treatment effects, while simultaneously highlighting the potential need
for additional postinjection rehabilitation aimed at improving performance.
Key Words
List of Abbreviations:
BMI (body mass index), ESI (epidural steroid injection), LSS (lumbar spinal stenosis), MCID (minimal clinically important difference), ODI (Oswestry Disability Index), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SPWT (Self-Paced Walking Test)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 04, 2012
Footnotes
Supported by the Spine Program of the University of Michigan, which was funded during the time of this project by the US Department of Health and Human Services, National Institutes of Health (grant no. 5 R01 NS41855-02). The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the US Department of Health and Human Services.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Jul 7, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
