Doctor of Philosophy (PhD) in Physical Therapy
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College of Health Care Sciences - Physical Therapy Department
Date of original Performance / Presentation
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Nova Southeastern University
Haitham Ramadan. 2019. Effectiveness of a Manual Therapy Approach in Treatment of Patients with Lumbar Spinal Stenosis. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences - Physical Therapy Department. (79)
Background: The use of manual therapy for the management of lumbar spinal stenosis (LSS) has not been adequately systematically reviewed in an attempt to determine its effectiveness on patients with LSS. The lack of evidence in support ofcommonly used conservative interventions continues to result in a lack of clarity regarding what interventions should be used to manage patients with LSS. Objective: To use a randomized comparative trial to compare the functional clinical outcomes achieved by patients with LSS receiving two different physical therapy interventions. Methods: In this randomized controlled trial, a total of40 participants diagnosed with LSS were randomized into two groups. Both groups received 6 weeks of treatment. Participants assigned to group 1 (EX Group) received impairment-based exercises. Participants assigned to group 2 (EXMT Group) received impairment-based exercises as well as manual physical therapy techniques. The evaluation parameters included (1) McGill Pain Questionnaire, (2) the original version of the Oswestry Low Back Pain Disability Questionnaire (ODQ), (3) double inclinometer measurement for measuring thoracolumbar flexion and extension, (4) self-pace walking test, (5) hip abductor and extensor strength, and (6) hip external rotation and extension range of motion. All participants were evaluated before starting treatment, once at the end of 6 weeks of treatment, and again at 6 weeks following the completion of treatment. Results: In terms of overall treatmentefficacy, there were notable improvements observed over time regardless of treatment group. Results indicated significant improvement in perceived disability using ODQ in the EXMT treatment group in comparison to the EX group at follow-up. For the EXMT group, there were notable improvements in comparison to the EX group in multiple objective functional improvement measures. Conclusion: Results of this study suggest that a multimodal approach using manual therapy and therapeutic exercises is an effective treatment option for providing clinically significant short-term reduction in back pain and disability, as well as improvements in back mobility in patients with LSS. Physical therapists should strongly consider the impairment-based approachof manual therapy and specific exercises program for lumbar spine and hips as a treatment option for patients with lumbarspinal stenosis.
Health and environmental sciences, Elderly, Impairment based approach, Lumbar spinal stenosis, Manual therapy, Physical therapy, Therapeutic exercise