Objective

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).

Data Sources

Systematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November 4, 2019, without language restrictions.

Study Selection

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.

Data Extraction

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.

Data Synthesis

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.

Conclusions

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.

中文翻译：

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保守性非药物治疗对退行性腰椎管狭窄症患者的疼痛、残疾、身体能力和身体活动行为的有效性：系统评价和荟萃分析

客观的

研究保守的非药物疗法对退行性腰椎管狭窄症 (LSS) 患者的疼痛、残疾、身体能力和身体活动结果的有效性。

数据源

从开始到 2019 年 11 月 4 日，系统搜索 MEDLINE、EMBASE、CENTRAL 和 PsycINFO，没有语言限制。

研究选择

成对的综述作者独立确定了发表在同行评审科学期刊上的随机对照试验，这些试验报告了康复干预对疼痛强度（背部或腿部）、残疾、症状严重程度、身体能力、身体活动行为或不良事件（次要结果）的影响) 在患有 LSS 的成年人中。搜索确定了 1718 条记录；包括来自 19 项试验（1432 名患者）的 21 份报告的数据。

数据提取

综述作者配对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，并使用推荐分级评估、制定和评估分类评估整体研究质量。

数据综合

我们使用随机效应荟萃分析汇总数据；治疗效果报告为平均差异 (MD) 和 95% 置信区间 (CI)。在改善短期步行能力（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）。极低质量的证据表明康复在改善中长期残疾方面并不比手术更好。单项试验为各种疗法的有效性提供了相互矛盾的证据。

结论

对于 LSS 患者，有低到中等质量的证据表明，与自我指导或集体锻炼相比，有监督锻炼的手法治疗可提高短期步行能力，并导致疼痛和症状严重程度的小幅改善。由于现有证据的质量非常低，LSS 在康复和手术之间的选择非常不确定。