Physiotherapy versus alternative medicine for pain and quality of life in patients with lumbar spinal stenosis: a systematic review with meta-analysis
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Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Ambala, India
Department of Physiotherapy, University Institute of Allied Health Sciences, Chandigarh University, Mohali, India
Department of Physiotherapy, School of Allied Health Science, Galgotias University, Greater Noida, India
Department of Orthopedics, Adesh Medical College, Pt. B. D. Sharma University, Rothak, India
Yenepoya Physiotherapy College (Deemed to be University), Yenepoya, India
Submission date: 2022-03-12
Acceptance date: 2022-09-27
Publication date: 2024-03-25
Corresponding author
Gurjant Singh   

MMIPR, Maharishi Markandeshwar (Deemed to be University) Mullana, Ambala, India
Physiother Quart. 2024;32(1):25-34
Lumbar spinal stenosis (LSS) is a prevailing condition widely affecting mobility. However, many non-invasive treatments have been proposed for LSS. Physiotherapy is reported as more commonly used with very little evidence reporting the efficacy of alternative medicine. For clinicians, there was a need to find a better mode of treatment. The purpose of this paper is to compare the effectiveness of physiotherapy interventions and alternative medicine for leg pain, back pain, and walking distance in patients with LSS.

Data sources: PubMed, Web of Science, and Scopus databases were searched for papers published in the previous 5 years (2016–2020). The systematic review and meta-analysis were conducted from September 2021 to December 2021 at the Musculoskeletal Research Lab of Maharishi Markandeshwaer Institute of Physiotherapy & Rehabilitation. Study selection and outcomes: randomised controlled trials (RCT), randomised clinical trials, randomised cross-over trials, quasi-RCTs, and non-RCTs were included if they evaluated the effects of physiotherapy or alternative medicine on pain and walking distance in patients with LSS. The Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), Self-paced walk test (SPWT), and treadmill walking were used as outcome measures. All the authors independently screened and extracted data from the 8 studies retrieved through the search using a pilot-tested performa. The quality of studies was assessed using the PEDro scale and the Cochrane risk of bias criteria.

Meta-analysis was performed using a fixed-effects model that showed (1) Physiotherapy was more effective than the control in improving leg pain. The Standardised mean difference (SMD) (95% CI) in the NRS score for leg pain was found to be 1.12 (0.83, 1.40); (2) Physiotherapy was more effective than the control in improving back pain. The SMD (95% CI) in the NRS score for back pain was 0.29 (−0.18, 0.76); (3) Physiotherapy was more effective than the control in improving walking distance. The SMD (95% CI) for walking distance was found to be 144.59 m (133.16 m, 159.02 m).

The results of the present study indicate that physiotherapy has higher significant results than alternative medicine in patients with lumbar spinal stenosis.

Fornari M, Robertson SC, Pereira P, Zileli M, Anania CD, Ferreira A, et al. Conservative treatment and percutaneous pain relief techniques in patients with lumbar spinal stenosis: WFNS Spine Committee Recommendations. World Neurosurg. 2020;10(7): 100079; doi: 10.1016/j.wnsx.2020.100079.
Anasuya GD, Jayashree A, Moorthy NLN, Madan S. Anatomical study of lumbar spinal canal diameter on MRI to assess spinal canal stenosis. Int J Anat Res. 2015;3(3):1441–1444; doi: 10.16965/ijar.2015.261.
Hennemann S, de Abreu MR. Degenerative lumbar spinal stenosis. Rev Bras Ortop. 2021;56(1):9–17; doi: 10.1055/s-0040-1712490.
Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al., Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9(7):545–550; doi: 10.1016/j.spinee.2009.03.005.Spinal.
Singh G, Sharma S, Kumar P, Goyal M, Samuel AJ. Correlation of functional claudication distance with canal diameter in patients with lumbar canal stenosis: a preliminary report. Physiother Quart. 2021;29(4):60–64; doi: 10.5114/PQ.2021.105755.
Comer CM, Redmond AC, Bird HA, Conaghan PG. Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists. BMC Musculoskelet Disord. 2009;10(1):121; doi: 10.1186/1471-2474-10-121.
Łozińska P, Wójtowicz D, Wdowiak P, Dziuba-Słonina A. Changes in kinematic parameters during walking in adults with low back pain subjected to Vojta therapy. A pilot study. Physiother Quart. 2019;27(2):22–28; doi: 10.5114/pq.2019.84273.
Azimi P, Mohammadi HR, Benzel EC, Shahzadi S, Az­hari S. Lumbar spinal canal stenosis classification criteria: a new tool. Asian Spine J. 2015;9(3):399–406; doi: 10.4184/asj.2015.9.3.399.
Kakadiya G, Saindane K, Soni Y, Gohil K, Shakya A, At­tar MU. Diabetes mellitus and the development of lumbar canal stenosis: is there any relevance? Asian Spine J. 2021;16(3): 326–333; 2021; doi: 10.31616/asj.2020.0566.
Ju J-H, Ha H-G, Jung C-K, Kim H-W, Lee C-Y, Kim J-H. Patterns of epidural venous varicosity in lumbar stenosis. Korean J Spine. 2012;9(3):244–249; doi: 10.14245/kjs.2012.9.3.244.
Kim K, Shin K-M, Hunt CL, Wang Z, Bauer BA, Kwon O, et al. Nonsurgical integrative inpatient treatments for symptomatic lumbar spinal stenosis: a multi-arm randomized controlled pilot trial. J Pain Res. 2019;12:1103–1113; doi: 10.2147/JPR.S173178.
Minetama M, Kawakami M, Teraguchi M, Kagotani R, Me­ra Y, Sumiya T, et al. Therapeutic advantages of frequent physical therapy sessions for patients with lumbar spinal stenosis. Spine. 2020;45(11):639–646; doi: 10.1097/BRS.0000000000003363.
Yamamoto Y, Kawakami M, Minetama M, Nakagawa M. Teraguchi M, Kagotani R, et al. Psychological predictors of satisfaction after lumbar surgery for lumbar spinal stenosis. Asian Spine J. 2022 Apr;16(2):270-278. doi: 10.31616/asj.2020.0402.
Mbada CE, Makinde MO, Odole AC, Dada OO, Ayanniyi O, Salami AJ, et al. Comparative effects of clinic- and virtual reality-based McKenzie extension therapy in chronic non-specific low-back pain. Hum Mov. 2019;20(3):66–79; doi: 10.5114/hm.2019.83998.
Ammendolia C, Côté P, Rampersaud YR, Southerst D, Schneider M, Ahmed A, Bombardier C, et al. Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial. Chiropr Man Therap. 2019;27,24; doi: 10.1186/s12998-019-0245-z.
Nakajima N, Tani T, Kiyasu K, Kumon M, Taniguchi S, Ta­kemasa R, et al. Unilateral repetitive tibial nerve stimulation improves neurogenic claudication and bilateral F-wave conduction in central lumbar spinal stenosis. J Orthop Sci. 2018;23(2):282–288; doi: 10.1016/j.jos.2017.12.006.
Lytras D, Iakovidis P, Kottaras A, Tsimerakis AF, Myrogiannis IS. A review on interferential current analgesic effects in individuals with chronic low back pain. Int J Phys Educ Sport Health. 2021;8(3):01–04; doi: 10.22271/kheljournal.2021.v8.i3a.2051.
Passmore SR, Johnson MG, Aloraini SM, Cooper S, Aziz M, Glazebrook CM. Impact of spinal manipulation on lower extremity motor control in lumbar spinal stenosis patients: a small-scale assessor-blind randomized clinical trial. J Manipulative Physiol Ther. 2019;42(1):23–33; doi: 10.1016/j.jmpt.2018.10.002.
Schneider MJ, Ammendolia C, Murphy DR, Glick RM, Hile E, Tudorascu DL, et al. Comparative clinical effectiveness of nonsurgical treatment methods in patients with lumbar spinal stenosis: a randomized clinical trial. JAMA Netw Open. 2019;2(1):e186828; doi: 10.1001/jamanetworkopen.2018.6828.
Rosenbaum P. Complementary and alternative therapies: what are our responsibilities? Dev Med Child Neurol. 2019;61(12):1352; doi: 10.1111/dmcn.14340.
Vaseghnia A, Shadmehr A, Moghadam BA, Olyaei G, Hadian MR, Khazaeipour Z. The therapeutic effects of manipulation technique on sacroiliac joint dysfunction in young women. Muscle Ligaments Tendons J. 2019;8(4):526; doi: 10.32098/mltj.04.2018.11.
Neelly K, Wallmann HW, Backus CJ. Validity of measuring leg length with a tape measure compared to a computed tomography scan. Physiother Theory Pract. 2013;29(6):487–492; doi: 10.3109/09593985.2012.755589.
Fryer G. Muscle energy technique: an evidence-informed approach. Int J Osteopat Med. 2011;14(1):3–9; doi: 10.1016/j.ijosm.2010.04.004.
Jarrett MS, Orlando JF, Grimmer-Somers K. The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review. BMC Musculoskelet Disord. 2012;13(1):30; doi: 10.1186/1471-2474-13-30.
Kim KH, Kim YR, Baik SK, Noh SH, Kim DH, Lee SW, et al. Acupuncture for patients with lumbar spinal stenosis: a randomised pilot trial. Acupunct Med. 2016;34(4):267–274; doi: 10.1136/acupmed-2015-010962.
Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, et al. Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial. Spine J. 2019;19(8):1310–1318; doi: 10.1016/j.spinee.2019.04.009.
Qin Z, Ding Y, Wu J, Zhou J, Yang L, Liu X, et al. Efficacy of acupuncture for degenerative lumbar spinal stenosis: protocol for a randomised sham acupuncture-controlled trial. BMJ Open. 2016;6(11): e012821; doi: 10.1136/bmjopen-2016-012821.
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