Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial
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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DOI：
10.1016/j.spinee.2018.07.012
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发表时间：
2019-03-01
期刊：
影响因子：
4.5
通讯作者：
Cote, Pierre
中科院分区：
文献类型：
--
作者：
Ammendolia, Carlo;Rampersaud, Y. Raja;Cote, Pierre
背景情况：腰椎管狭窄症（LSS）可损害脊髓神经的血流，导致神经源性跛行和行走能力受限。减少腰椎前凸可以增加椎管容积，减少神经缺血。我们开发了一种原型LSS带，旨在减少行走时的腰椎前凸。目的：本研究的目的是评估原型LSS带与腰椎支撑相比在改善退行性LSS患者行走能力方面的短期有效性。研究设计：这是一项双臂，双盲（参与者和评估者）随机对照试验。我们招募了104名年龄在50岁或以上的参与者，他们患有神经源性跛行，影像学证实为退行性LSS，结果测量：主要测量是通过自步速步行试验（SPWT）测量的步行距离，主要结果是两组参与者中步行距离较基线至少改善30%的比例差异，使用相对风险和95%置信区间。在基线SPWT的1周内，随机分配至原型LSS腰带组（n=52）的受试者和随机分配至腰部支撑组（n=52）的受试者由设盲评估者进行SPWT。关节炎协会资助了这项研究（$365，000 CAN）与工资支持的主要研究者由加拿大脊椎按摩疗法研究基金会资助（$500，000 CAN为5 years）。结果：两组都表现出步行距离的显着改善，但组间无显着差异。步行距离的平均组间差异为-74 m（95% CI：-282.8至134.8，p= 0.49）。总的来说，62%的佩戴原型LSS带的参与者和82%的佩戴腰部支撑的参与者实现了至少30%的步行距离改善（相对风险，0.7; 95%CI：0.5-1.3，p= 0.43）。结论：原型LSS带显示出退行性LSS患者步行能力的显著改善，但并不比腰部支撑更好。(C)2018爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: Lumbar 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.PURPOSE: The 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 DESIGN: This was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLE: We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURES: The 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.METHODS: Within 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).RESULTS: Both 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).CONCLUSIONS: A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. (C) 2018 Elsevier Inc. All rights reserved.