Implementation of a Non‐Operative, Non‐Pharmacological Lumbar Spinal Stenosis Clinic at a Single
VA
Medical Center
Zachary A. Cupler, Michael J. Schneider, Robin L. P. Jump, Kevin S. Mathers ABSTRACT
Background
Lumbar spinal stenosis (LSS), prevalent among older adults, causes debilitating back and/or leg pain during ambulation. Declining physical fitness, increased risk of falls, and unintended consequences of analgesic medications compound LSS‐related health concerns. Recent clinical studies described using a structured comprehensive training program and manual therapy/individualized exercises to achieve effective and safe management of LSS. Here we describe a clinical demonstration project that implemented an LSS clinic in a real‐world clinical setting.
Participants and Setting
Patients referred to the LSS clinic at a Veterans Affairs (VA) medical center from January through December 2024.
Methods
The LSS clinic delivered a biopsychosocial multi‐modal rehabilitative program that included 12 visits over 6 weeks. We assessed two patient‐reported outcomes: Pain, Enjoyment, and General Activity Scale (PEG‐3) and Patient Specific Functional Scale (PSFS); and three performance‐based outcomes: 6‐min walk test (6MWT), 5‐times sit to stand test (5XSST), and daily steps.
Results
Of the 67 patients who were clinically appropriate for the LSS clinic, 64 (96%) were male and had a mean age of 73.9 ± 8.2 years. Among those, 42 (63%) completed ≥ 9 visits (mean 11.7 ± 0.7 visits) while the remaining 25 (37%) completed eight or fewer visits (mean 3.1 ± 3.1 visits). Patients who completed ≥ 9 visits had significant within‐group improvements in the PEG‐3 (6.2 vs. 4.2, p < 0.001), PSFS (3.7 vs. 5.9, p < 0.001), 6MWT (879 vs. 1118 ft, p < 0.001), 5XSST (20.4 vs. 13.5 s, p < 0.001), and daily steps (3434 vs. 4306 steps; p < 0.05).
Conclusions
Outcomes indicate successful implementation of the LSS clinic at a single VA medical center. Veterans who completed ≥ 9 visits achieved clinically meaningful changes in patient‐reported and performance‐based outcomes. Dissemination of the LSS clinic to additional VA medical centers has strong potential to improve function and enhance the quality of life for other Veterans.