Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China.
School of Health, Fujian Medical University, 350108, Fuzhou, Fujian, China.
BMC Musculoskelet Disord. 2023 Mar 16;24(1):198. doi: 10.1186/s12891-023-06305-0.
Propensity-matched retrospective study.
To determine whether type 2 diabetes mellitus (T2D) would affect prognosis in patients with degenerative lumbar spinal stenosis (DLSS) who underwent therapeutic exercises.
This study included consecutive patients with or without T2D who underwent therapeutic exercises for symptomatic DLSS from December 2018 to January 2020. Baseline demographics and clinical and radiological data were collected. The 2 groups of patients were further matched in a 1:1 fashion based on the propensity score, balancing the groups on pre-treatment factors including age, sex, leg and back pain, and low back disability. The primary outcomes included self-reported leg pain intensity (Numerical Rating Scale, NRS) and low back disability (Oswestry Disability Index, ODI) and the secondary outcomes included low back pain intensity and walking capacity (self-paced walking test, SPWT) were compared at baseline, 6 weeks, and 12 weeks.
Forty-one pairs of patients were selected by propensity matching. After 6-week therapeutic exercises, patients with T2D achieved a lower improvement in leg pain at 6 weeks (NRS leg change, 1.21 ± 0.40 vs. 1.78 ± 0.52, P = 0.021) and 12 weeks (NRS leg change, 1.52 ± 0.92 vs. 2.18 ± 0.96, P = 0.007) above minimal clinically important difference (MCID), with a significant Group × Time interactions (F = 16.32, p < 0.001, ηp2 = 0.053). However, the two groups showed no difference in the improvement of ODI, although the sample had significant improvements at 6 weeks (ODI change 3.02 [95% CI, 2.08 to 2.77], P < 0.001) and 12 weeks ([ODI change 3.82 [95% CI, 4.03 to 4.90], P < 0.001), 46% of the patients achieved an MCID.
Six-week therapeutic exercises have an inferior effect on DLSS patients with T2D. Findings from this study will provide an increased understanding of exercise treatment in patients with DLSS.
倾向匹配回顾性研究。
确定 2 型糖尿病（T2D）是否会影响接受治疗性运动的退行性腰椎管狭窄症（DLSS）患者的预后。
本研究纳入了 2018 年 12 月至 2020 年 1 月期间因症状性 DLSS 接受治疗性运动的 T2D 或非 T2D 患者。收集基线人口统计学和临床及影像学数据。根据倾向评分，将两组患者以 1:1 的比例进一步匹配，根据治疗前因素平衡两组患者，包括年龄、性别、腿部和背部疼痛以及下腰痛残疾。主要结局包括自我报告的腿部疼痛强度（数字评分量表，NRS）和下腰痛残疾（Oswestry 残疾指数，ODI），次要结局包括下腰痛强度和步行能力（自我定速步行测试，SPWT），在基线、6 周和 12 周进行比较。
通过倾向评分匹配选择了 41 对患者。经过 6 周的治疗性运动，T2D 患者在 6 周时腿部疼痛的改善程度较低（NRS 腿部变化，1.21±0.40 对 1.78±0.52，P=0.021）和 12 周时腿部疼痛的改善程度较低（NRS 腿部变化，1.52±0.92 对 2.18±0.96，P=0.007）高于最小临床重要差异（MCID），存在显著的组间×时间交互作用（F=16.32，p<0.001，ηp2=0.053）。然而，两组在 ODI 的改善方面没有差异，尽管样本在 6 周时（ODI 变化 3.02 [95%CI，2.08 至 2.77]，P<0.001）和 12 周时（ODI 变化 3.82 [95%CI，4.03 至 4.90]，P<0.001）有显著改善，46%的患者达到了 MCID。
6 周的治疗性运动对患有 T2D 的 DLSS 患者的疗效较差。本研究的结果将提高对 DLSS 患者运动治疗的认识。
