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ALEXANDRIA, VA, April 8, 2015 — A study published on Monday, April 7, in the Annals of Internal Medicine shows that physical therapy is just as effective as decompression surgery for relieving symptoms and improving function in patients with lumbar spinal stenosis (LSS).
The study compared surgical decompression with a specified physical therapy regimen in patients who were considered surgical candidates for symptomatic and degenerative LSS. The study is the first to directly compare a single, evidence-based, physical therapy regimen with decompression surgery among patients who agreed to be randomly assigned to either approach.
The 169 study participants were randomly assigned to 1 of 2 treatment groups: 87 to the surgical decompression group and 82 to physical therapy. After 2 years, patients in both groups experienced similar reduction in pain and other symptoms. According to the study's lead author Anthony Delitto, PT, PhD, FAPTA, of the University of Pittsburgh, "Physical therapy should be fully considered as an equally effective, less risky, and much less costly first treatment option in patients who are candidates for decompression surgery."
Patients' physical function was evaluated primarily through self-reported outcomes—first at 10 weeks and then at 6, 12, and 24 months. While more than half (57%) of the physical therapy group elected to have surgery at some point within the 2-year study window, analysis revealed that even with this shift, "any differences between the groups were not significant."
In an accompanying editorial Jeffrey N. Katz, MD, MSc, said that data from this and other studies suggest that "patients with LSS should be offered a rigorous, standardized PT regimen. Those who do not improve and ultimately consider surgery should be informed that the benefits are likely to diminish over time." He added, "Because long-term outcomes are similar for both treatments yet short-term risks differ, patient preferences should weigh heavily in the decision of whether to have surgery for LSS."
Physical therapist treatments included instruction on lumbar flexion exercises, general conditioning exercises such as stationary cycling or treadmill walking, lower extremity strengthening exercises, and patient education to avoid postures involving hyperextension of the lumbar spine.
According to American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS, "Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS."
The American Physical Therapy Association represents more than 90,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about the types of conditions physical therapists can treat, and find a physical therapist in your area, by visiting www.MoveForwardPT.com. Follow Move Forward PT on Twitter and Facebook.