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Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial

Published:January 28, 2019DOI:https://doi.org/10.1016/j.apmr.2018.12.035

      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)
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