Patients' experience with nonsurgical treatment for lumbar spinal stenosis: a qualitative study

BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. Research into optimal nonsurgical treatment approaches for LSS is lacking. PURPOSE: The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of nonsurgical LSS treatments regarding the interventions they received, factors contributing to adherence to the interventions, and methods of outcomes assessment. STUDY DESIGN/SETTING: This study used a qualitative focus group design conducted at an academic research center. PATIENT SAMPLE: Individuals participating in a randomized clinical trial (RCT) for nonsurgical LSS treatment were invited to discuss their study treatments and general experiences with LSS. The three treatment arms in the study were medical care, community-based group exercise, and clinic-based manual therapy and individual exercise. OUTCOME MEASURES: Following coding of qualitative data, kappa statistic was used to calculate agreement between observers. Themes were identified and agreed upon by both coders. METHODS: This study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Fifty individuals (28 women, mean age 73 +/- 7.7 years) participated in a focus group. Two focus groups based on modified grounded theory were held for participants of each of the three treatment arms, for a total of six focus groups. Discussion topics included perceived effectiveness of the assigned treatment, suggestions for improvement, barriers and facilitators to completing treatment, and opinions of research outcome measures. RESULTS: Several themes were evident across all treatment groups. First, patients prefer individualized treatment that is tailored to their specific impairments and functional limitations. They also want to learn self-management strategies to rely less upon formal health care providers. Participants consistently stated that exercise improved their pain levels and physical function. However, they noted that these effects are temporary, so commitment to exercising long-term is important. Common barriers to completing the assigned LSS treatment included transportation issues and other comorbid health conditions. All three treatment groups cited perceived treatment benefit as a strong facilitator to continuing treatment. In addition, the ability of the health care provider to relate to the patient and listen to the patient's concerns was a common facilitator. Within the community-based group exercise treatment arm, most individuals continued group exercise after study completion, and social support was often mentioned as a facilitator to continuing treatment. Medical care was most often associated with minimal to no effect of treatment. CONCLUSIONS: Many individuals with LSS report barriers to accessing non-surgical treatment, but may also be willing to commit to a long-term treatment strategy that includes exercise. Social support from others with LSS and from health care providers with good communication skills may facilitate compliance with treatment recommendations. (C) 2017 Elsevier Inc. All rights reserved.