Physical Therapy May Equal Surgery For Spinal Stenosis, But Many Patients Don’t Complete Treatments

Anthony Delitto, PT, Ph.D, FAPTA Professor and Chair Department of Physical Therapy Associate Dean for Research, SHRS School of Health and Rehabilitation Sciences Pittsburgh,MedicalResearch.com Interview with:
Anthony Delitto, PT, Ph.D, FAPTA

Professor and Chair
Department of Physical Therapy
Associate Dean for Research, SHRS
School of Health and Rehabilitation Sciences
University of Pittsburgh

Medical Research: What is the background for this study? What are the main findings?

Dr. Delitto: I work with a team, many of whom were authors on the paper, and we see a lot of patients with lumbar spinal stenosis. Some of them did very well with Physical Therapy and avoided surgery. Some people didn’t do well and we ended up having surgery. We really wanted to do a study that compared, in a randomized format, doing surgery vs. a non-surgical approach to lumbar spinal stenosis. The idea we had was to really put the two approaches head to head – a randomized trial of surgery vs. physical therapy for people with lumbar spinal stenosis. We decided only to recruit patients after they had consented to surgery in order to avoid the pitfalls of previous studies where people crossed over after being assigned to a group, for example, being assigned to surgery and then deciding against having surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Delitto: Probably the biggest point to put across to physicians, patients and practitioners, one of the things we realized was: patients don’t exhaust all of their non-surgical options before they consent to surgery. And physical therapy is one of the non-surgical options. The obvious finding is, when you compare the two groups, they seem to do the same. The results were equivalent at two years. Now, embedded in that, there are patients who did well in surgery, and patients who failed in surgery. There are patients who did well in Physical Therapy, and there are patients who failed with PT. But when we looked across the board at all of those groups, their success and failure rates were about the same. So it tells us that for the most part there were equivalent outcomes at two years.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Delitto: There are 2 issues that we really want to explore a lot further and we think make a big impact in the management of patients with Lumbar Spinal Stenosis.

First and foremost, what are the predictors of success and failure with surgery and with Physical Therapy, and are those predictors different? If they were different, that would give us a real clear indications about how to better direct patients.

The other major finding that we really want to pursue more, when we looked at our date of all the people who received surgery, it seemed as if women didn’t do as well as men – especially over time.  Both women and men improved in the first part of the post-surgical period. But toward the end, the men continued to improve but the women didn’t. Both improved, and they improved at the same degree.

Finally, most patients didn’t finish their PT regimen. In fact, the majority of the patients didn’t even do half of their regimen. There was another substantial number of patients that didn’t even go to 1 treatment. They had agreed to consider Physical Therapy, but I think a lot of patients don’t understand what Physical Therapy entails. One of the big things that we know held patients back from physical therapy were co-payments. Patients realized they had a co-payment every time they went to a physical therapist, and I think that was one of the major limiting factors in getting people to complete their physical therapy regiment.  Patients were on Medicare…and a lot of them were on fixed incomes. Some of those co-payments had to come out of pocket. And some of these co-payments are $25, $30, $35 per visit. That adds up, and some of the patients just couldn’t afford it.

Citation:

Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial

Ann Intern Med. 2015;162(7):465-473. doi:10.7326/M14-1420

MedicalResearch.com Interview with: Anthony Delitto, PT, Ph.D, FAPTA (2015). Physical Therapy May Equal Surgery For Spinal Stenosis, But Many Patients Don’t Complete PT 

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