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Physical therapy as effective as surgery for spinal stenosis: study

shutterstock_86846005.jpgA new study from the University of Pittsburgh in Pennsylvania reveals physical therapy may be just as effective as surgical intervention for patients with lumbar spinal stenosis.


April 7, 2015
By Massage Therapy Canada staff

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In a two-year study published Monday in Annals of Internal Medicine,
university researchers found symptoms from lumbar spinal stenosis, an
anatomical impairment common with aging, were relieved and function
improved in as many patients utilizing physical therapy as those taking
the surgical route.

It is the first study that clearly compared
outcomes between surgery and an evidence-based, standardized physical
therapy approach for lumbar spinal stenosis. The condition, created by a
narrowing of the spinal canal that puts pressure on the nerve roots
resulting in pain, numbness and weakness through the back and lower
extremities, has caused decompression surgery to become the
fastest-growing intervention in today’s older population.

A total
of 169 patients aged 50 and over already headed for decompression
surgery agreed to be randomly assigned into two groups: Those who would
have the procedure, and those who went through two standardized,
evidence-based physical therapy sessions per week for six weeks. After
both groups were re-examined at intervals of six months, one year and
two years, the patient outcomes appeared to be equal. There were no
detectable differences between the groups in how their pain abated and
the degree to which function was restored in their backs, buttocks and
legs.

“Probably the biggest point to put across to physicians,
patients and practitioners is: Patients don’t exhaust all of their
non-surgical options before they consent to surgery. And physical
therapy is one of their non-surgical options,” said principal
investigator Anthony Delitto, chair of the Department of Physical
Therapy, Pitt School of Health and Rehabilitation Sciences (SHRS), as
well as a member of Pitt’s Health Policy Institute (HPI).

Delitto,
a physical therapist, and his SHRS colleagues have long puzzled over
why some patients reacted well to physical therapy (PT) and others to
surgery.

“The idea we had was to really test the two approaches
head to head,” he said. “Both groups improved, and they improved to the
same degree. Now, embedded in that, there are patients who did well in
surgery, and patients who failed in surgery. There are patients who did
well in PT, and there are patients who failed with PT. But when we
looked across the board at all of those groups, their success and
failure rates were about the same.”

The research project also
revealed issues surrounding physical therapy appointments and the cost
of co-pay, which may prove enlightening to policymakers enmeshed in the
charged atmosphere around health care, Delitto added.

Most
patients didn’t finish the physical therapy regimen allowed them under
Medicare and prescribed by the researchers, and one-third of the
patients failed to complete even half of the regimen. Another 16 per
cent didn’t show for a single treatment, though they had agreed to
consider physical therapy.

“One of the big things that we know
held patients back from PT were co-payments,” Delitto said. “Patients
were on Medicare, and a lot of them were on fixed incomes. Some of those
co-payments had to come out of pocket at $25, $30, $35 per visit. That
adds up, and some of the patients just couldn’t afford it.”

This
publication marks the fourth national announcement in the past two
months involving Pitt research into back pain and PT treatments.

The
Foundation of Physical Therapy announced in early February that SHRS
and HPI are being partnered with Brown and Boston universities in a
five-year, $2.5 million program to generate pilot studies as part of the
Center on Health Services Training and Research, the first-ever grant
to train future researchers and scientists in PT.

In
mid-February, Spine published a Pitt/UPMC research project showing the
early addition of manual-thrust manipulation leads to significantly
greater reductions in low-back pain and improved function at four weeks.
The belief of therapeutic equivalence between manual-thrust
manipulation and mechanical manipulation devices isn’t supported by the
current evidence, wrote the team led by Michael Schneider, Ph.D.,
assistant professor of physical therapy, SHRS. The study was supported
by the U.S. National Institutes of Health and National Center for
Complementary and Alternative Medicine.

In late February, the
Patient-Centered Outcomes Research Institute awarded $14 million to UPMC
and Pitt through the HPI’s Comparative Effectiveness Research Center to
lead a clinical trial to determine how well an intervention that helps
people better understand their back pain early on works toward promoting
recovery and ultimately preventing chronic pain.

Delitto’s
fellow researchers included: Pitt’s Deborah A. Josbeno and Sara R. Piva
of SHRS, and Stephen R. Wisniewski of the Graduate School of Public
Health; Dr. Mark Fye, of UPMC orthopaedic surgery; Carolinas Healthcare
System’s Charity G. Moore, previously with the Pitt Department of
Medicine; the University of Utah’s Julie M. Fritz; and the University of
Pennsylvania’s Dr. William C. Welch

The project was funded by
grant AR-NS45622 from the U.S. National Institutes of Health and
National Institute of Arthritis and Musculoskeletal and Skin Diseases.


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