Abstract
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education
with and without physical therapy (PT) in individuals with lumbar spinal stenosis
(LSS).
Design
Randomized clinical trial.
Setting
Orthopedic spine clinics.
Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to
receive ESI and education with or without PT (N=54).
Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention
period, with 31 receiving injections and education only (ESI) and 23 additionally
receiving 8-10 sessions of multimodal PT (ESI+PT).
Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10
weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.
Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability
Index at any time point, although the sample had significant improvements at 10 weeks
(P<.001; 95% confidence interval [CI], −18.01 to −5.51) and 1 year (P=.01; 95% CI, −14.57 to −2.03) above minimal clinically important difference. Significant
differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT
at 10 weeks with higher emotional role function (P=.03; 95% CI, −49.05 to −8.01), emotional well-being (P=.02; 95% CI, −19.52 to -2.99), and general health perception (P=.05; 95% CI, −17.20 to −.78).
Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability
in individuals with LSS. Significant benefit was found for the addition of PT related
to quality of life factors of emotional function, emotional well-being, and perception
of general health.
Keywords
List of abbreviations:
CI (confidence interval), ESI (epidural steroid injection), GRC (global rating of change), LBP (low back pain), LSS (lumbar spinal stenosis), MCID (minimal clinically important difference), MD (mean difference), NPRS (numeric pain rating scale), ODI (Oswestry Disability Index), PT (physical therapy), SF-36 (RAND 36-Item Short Form Health Survey 1.0)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 28, 2019
Footnotes
Clinical Trial Registration No.: NCT00786981.
Supported by the Orthopaedic Section of the American Physical Therapy Association, United States. The funder played no role in the design of the study, interpretation of the data, or decision to publish this work.
Disclosures: none.
Identification
Copyright
© 2019 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
