Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.
College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.
Arch Phys Med Rehabil. 2021 Nov;102(11):2247-2260.e7. doi: 10.1016/j.apmr.2021.03.033. Epub 2021 Apr 29.
To investigate the effectiveness of conservative nonpharmacologic therapies on pain, disability, physical capacity, and physical activity outcomes in patients with degenerative lumbar spinal stenosis (LSS).
Systematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November 4, 2019, without language restrictions.
Pairs of review authors independently identified randomized controlled trials published in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions on pain intensity (back or leg), disability, symptom severity, physical capacity, physical activity behavior, or adverse events (secondary outcome) in adults with LSS. The search identified 1718 records; data from 21 reports of 19 trials (1432 patients) were included.
Review author pairs independently extracted data and assessed included studies. We assessed risk of bias with the Cochrane tool, and overall study quality with the Grading of Recommendations Assessment, Development and Evaluation classification.
We pooled data using random-effects meta-analyses; treatment effects were reported as mean differences (MD) and 95% confidence intervals (CI). Directed exercise and manual therapy was superior to self-directed or group exercise for improving short-term walking capacity (MD, 293.3 m; 95% CI, 61.7-524.9 m; low-quality evidence), back pain (MD, -1.1; 95% CI, -1.8 to -0.4; moderate quality evidence), leg pain (MD, -.9; 95% CI, -0.2 to -1.5; moderate-quality evidence), and symptom severity (MD, -0.3; 95% CI, -0.4 to -0.2; low quality evidence). There is very low quality evidence that rehabilitation is no better than surgery at improving intermediate- or long-term disability. Single trials provided conflicting evidence of effectiveness for a variety of therapies.
For patients with LSS, there is low- to moderate-quality evidence that manual therapy with supervised exercises improves short-term walking capacity and results in small improvements in pain and symptom severity compared with self-directed or group exercise. The choice between rehabilitation and surgery for LSS is very uncertain owing to the very low quality of available evidence.
探讨退行性腰椎管狭窄症（LSS）患者保守非药物治疗在疼痛、残疾、体能和身体活动结果方面的有效性。
系统检索 MEDLINE、EMBASE、CENTRAL 和 PsycINFO 从成立到 2019 年 11 月 4 日，不限制语言。
由两位评论作者独立确定发表在同行评议科学期刊上的随机对照试验，报告康复干预对 LSS 成人疼痛强度（背部或腿部）、残疾、症状严重程度、体能、身体活动行为或不良反应（次要结果）的影响。搜索确定了 1718 条记录；纳入了 21 项研究报告的 19 项试验（1432 名患者）的数据。
由两位评论作者独立提取数据并评估纳入的研究。我们使用 Cochrane 工具评估偏倚风险，并使用推荐评估、制定和评估分级法评估总体研究质量。
我们使用随机效应荟萃分析汇总数据；治疗效果以均数差（MD）和 95%置信区间（CI）报告。定向运动和手动治疗优于自我指导或小组运动，可改善短期步行能力（MD，293.3 m；95%CI，61.7-524.9 m；低质量证据）、背部疼痛（MD，-1.1；95%CI，-1.8 至-0.4；中等质量证据）、腿部疼痛（MD，-.9；95%CI，-0.2 至-1.5；中等质量证据）和症状严重程度（MD，-0.3；95%CI，-0.4 至-0.2；低质量证据）。有非常低质量的证据表明，康复治疗与手术治疗在改善中期或长期残疾方面并无差异。单一试验对各种治疗方法的有效性提供了相互矛盾的证据。
对于 LSS 患者，有低至中等质量的证据表明，与自我指导或小组运动相比，监督下的手动治疗加运动可改善短期步行能力，并使疼痛和症状严重程度略有改善。由于现有证据质量非常低，因此对于 LSS，康复治疗与手术治疗的选择非常不确定。
