Abstract
Objective
To investigate the effectiveness of conservative nonpharmacologic therapies on pain,
disability, physical capacity, and physical activity outcomes in patients with degenerative
lumbar spinal stenosis (LSS).
Data Sources
Systematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November
4, 2019, without language restrictions.
Study Selection
Pairs of review authors independently identified randomized controlled trials published
in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions
on pain intensity (back or leg), disability, symptom severity, physical capacity,
physical activity behavior, or adverse events (secondary outcome) in adults with LSS.
The search identified 1718 records; data from 21 reports of 19 trials (1432 patients)
were included.
Data Extraction
Review author pairs independently extracted data and assessed included studies. We
assessed risk of bias with the Cochrane tool, and overall study quality with the Grading
of Recommendations Assessment, Development and Evaluation classification.
Data Synthesis
We pooled data using random-effects meta-analyses; treatment effects were reported
as mean differences (MD) and 95% confidence intervals (CI). Directed exercise and
manual therapy was superior to self-directed or group exercise for improving short-term
walking capacity (MD, 293.3 m; 95% CI, 61.7-524.9 m; low-quality evidence), back pain
(MD, –1.1; 95% CI, –1.8 to –0.4; moderate quality evidence), leg pain (MD, –.9; 95%
CI, –0.2 to –1.5; moderate-quality evidence), and symptom severity (MD, –0.3; 95%
CI, –0.4 to –0.2; low quality evidence). There is very low quality evidence that rehabilitation
is no better than surgery at improving intermediate- or long-term disability. Single
trials provided conflicting evidence of effectiveness for a variety of therapies.
Conclusions
For patients with LSS, there is low- to moderate-quality evidence that manual therapy
with supervised exercises improves short-term walking capacity and results in small
improvements in pain and symptom severity compared with self-directed or group exercise.
The choice between rehabilitation and surgery for LSS is very uncertain owing to the
very low quality of available evidence.
Keywords
List of abbreviations:
CI (confidence interval), GRADE (Grading of Recommendations Assessment, Development and Evaluation classification), LSS (lumbar spinal stenosis), MD (mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 29, 2021
Accepted:
March 27,
2021
Received in revised form:
February 12,
2021
Received:
October 20,
2020
Footnotes
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
