Question: Is 6 weeks of treadmill walking with body weight support more effective than cycling in people with lumbar spinal stenosis when added to an exercise program?
Design: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
Participants: Sixty-eight patients aged 58 (SD 8) with symptoms of lumbar spinal stenosis for 12 weeks (SD 49).
Intervention: Participants performed either treadmill with body weight support or cycling, twice weekly, for 6 weeks. Both groups also received an exercise program consisting of heat, lumbar traction, and flexion exercises.
Outcome measures: The primary outcome was disability measured using the modified Oswestry Disability Index. Secondary outcomes were disability, measured using the Roland-Morris Disability Questionnaire, pain severity, and patient perceived benefit. Measures were collected midway through intervention at 3 weeks and after intervention at 6 weeks.
Results: There was no difference between the groups in reduction in disability or pain over the 6-week intervention period. The between-group difference in the modified Oswestry Disability Index was 3.2 points (95% CI -3.1 to 7.7) at 6 weeks, and in pain severity was 2 mm on a 100 visual analogue scale (95% CI -5 to 10). Furthermore, the wide confidence intervals associated with estimates of patient benefit are consistent with no difference between the two groups. However, both groups did improve.
Conclusion: Treadmill with body weight support and cycling may be equally effective in the conservative management of people with lumbar spinal stenosis. However, the improvement observed in both groups was probably a combination of the intervention and the natural course of recovery of lumbar spinal stenosis.