PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2010

Clinical Scenario

I am currently working with an older adult who has severe spondylosis as well as spinal stenosis of her lumbar and cervical spine. This patient is not a good candidate for spinal surgery due to her other health conditions. Therefore, I was interested in finding a non-surgical intervention incorporating activities she enjoys; such as walking. I wanted to know if BWSTT would give the same results as back stabilization exercises. I would like to determine whether using BWSTT as a critical component within a comprehensive treatment program for spinal stenosis is beneficial. For many older adults their main form of physical activity is walking. Therefore, I wanted to find an intervention that implemented activities older adults would be familiar with to encourage compliance.

Clinical Question

Population: Adults with spinal stenosis

Intervention: BWSTT

Comparison: Back stabilization exercises without BWSTT

Outcome: Pain rating scale and functional index survey

Clinical Bottom Line

I evaluated two articles written between the years of 2006 and 2007 that assessed the use of body weight support treadmill training (BWSTT) with adults with lumbar spinal stenosis (LSS). These studies did not support the use of BWSTT in treating adults who are not good candidates for surgery to correct LSS. The articles by Whitman et al. and Pua et al. are not very good matches to my clinical question, though they were of excellent quality (both ranking 8/10 on the PEDro scale). The Whitman et al. article was a randomized controlled trial with 58 older adults with LSS comparing manual physical therapy, flexion exercises and BWSTT to flexion exercises, sub-therapeutic ultrasound, and treadmill walking. Pua et al. used a randomized controlled trial design with 68 older adults with LSS and compared BWSTT to cycling in conjunction with an exercise program and mechanical lumbar traction. The results of these articles show no statistically significant difference between interventions over 6 weeks. The effect size between groups (95% CI) according to the Whitman et al. and Pua et al. studies are 0.29 (-0.23 – 0.8) and 0.19 (-0.29 – 0.66) respectively; indicating a very small change that either intervention would have reduced pain or improved functional capabilities for subjects. The overlap or going below zero of the 95% CI signifies subjects could have gotten worse with treatment. For improvements in functional capabilities, the NNT according to the Pua et al. article was 45 (-4.8 – 3.9). Both of these articles had adequate internal validity. Based on the evidence, I would not incorporate BWSTT in my treatment program as an intervention for older adults with LSS. There is no statistical significance for either study, thus further research is needed in order to accept any potential results. These articles would not affect my treatment interventions for older adults with LSS who do not qualify for surgery.

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