Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial |
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| Authors: | Carlo Ammendolia Y Raja Rampersaud Danielle Southerst Aksa Ahmed Michael Schneider Gillian Hawker Claire Bombardier Pierre Côté |
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| Affiliation: | 1. Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON Canada M5T 3M6;2. Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, 60 Murray Street, Room L2-225, Toronto, Ontario M5T 3L9, Canada;3. Department of Orthopedics, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON Canada M5T 2S8;4. Occupational and Industrial Center, Department of Orthopaedic Surgery, NYU Langone Health, 63 Downing St. New York, NY 10014, USA;5. Department of Physical Therapy, University of Pittsburgh, 4028 Forbes Tower Pittsburgh, PA 15260, USA;6. Department of Medicine, Division of Rheumatology, University of Toronto, Medical Sciences Building, 1 King''s College Cir, Toronto, Ontario, Canada, M5S 1A8;7. Department of Medicine, University of Toronto, Medical Sciences Building, 1 King''s College Cir, Toronto, Ontario, Canada M5S 1A8;8. Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, Canada, M5T 3M7;9. UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North Oshawa, Ontario, Canada L1H 7K4 |
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| Abstract: | BACKGROUND CONTEXTLumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking.PURPOSEThe aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS.STUDY DESIGNThis was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLEWe recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURESThe primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals.METHODSWithin 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years).RESULTSBoth groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was ?74 m (95% CI: ?282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5–1.3, p=.43).CONCLUSIONSA prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. |
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| Keywords: | Intermittent claudication LSS Lumbar belt Lumbar support Nonoperative treatment Randomized controlled trial Walking |
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