Charlotte Pauwels1, Alexandra Roren2, Adrien Gautier3, Jonathan Linières3, François Rannou4, Serge Poiraudeau5, Christelle Nguyen6. 1. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, Sorbonne-Paris-Cité, Paris, France. 2. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm UMR 1153, centre de recherche épidémiologie et statistique, Sorbonne-Paris-Cité, ECaMO Team, Paris, France. 3. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. 4. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, Sorbonne-Paris-Cité, Paris, France; Inserm UMR 1124, Laboratoire de pharmacologie, toxicologie et signalisation cellulaire, faculté des sciences fondamentales et biomédicales, centre universitaire des Saints-Pères, Paris, France. 5. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, Sorbonne-Paris-Cité, Paris, France; Inserm UMR 1153, centre de recherche épidémiologie et statistique, Sorbonne-Paris-Cité, ECaMO Team, Paris, France; Institut fédératif de recherche sur le handicap, Paris, France. 6. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, groupe hospitalier Cochin, hôpitaux universitaires Paris-Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, Sorbonne-Paris-Cité, Paris, France; Inserm UMR 1124, Laboratoire de pharmacologie, toxicologie et signalisation cellulaire, faculté des sciences fondamentales et biomédicales, centre universitaire des Saints-Pères, Paris, France. Electronic address: christelle.nguyen2@aphp.fr.
Abstract
BACKGROUND: Lumbar-flexion-based endurance training, namely cycling, could be effective in reducing pain and improving function and health-related quality of life in older people with chronic low back pain. OBJECTIVES: To assess barriers and facilitators to home-based cycling in older patients with lumbar spinal stenosis (LSS). METHODS: We conducted a retrospective mixed-method study. Patients≥50 years old followed up for LSS from November 2015 to June 2016 in a French tertiary care center were screened. The intervention consisted of a single supervised session followed by home-based sessions of cycling, with dose (number of sessions and duration, distance and power per session) self-determined by patient preference. The primary outcome was assessed by a qualitative approach using semi-structured interviews at baseline and 3 months and was the identification of barriers and facilitators to the intervention. Secondary outcomes were assessed by a quantitative approach and were adherence monitored by a USB stick connected to the bicycle, burden of treatment assessed by the Exercise Therapy Burden Questionnaire (ETBQ) and clinical efficacy assessed by change in lumbar pain, radicular pain, disability, spine-specific activity limitation and maximum walking distance at 3 months. RESULTS: Overall, 15 patients were included and data for 12 were analyzed at 3 months. At baseline, the mean age was 70.9 years (95% CI: 64.9-76.8) and 9/15 patients (60.0%) were women. Barriers to cycling were fear of pain and fatigue, a too large bicycle, burden of hospital follow-up and lack of time and motivation. Facilitators were clinical improvement, surveillance and ease-of-use of the bicycle. Adherence remained stable overtime. The burden of treatment was low [mean ETBQ score: 21.0 (95% confidence interval: 11.5-30.5)]. At 3 months, 7/12 patients (58.3%) self-reported clinical improvement, with reduced radicular pain and disability [mean absolute differences: -27.5 (-43.3 to -11.7), P<0.01 and -17.5 (-32.1 to -2.9), P=0.01, respectively]. CONCLUSIONS: For people with LSS, home-based cycling is a feasible intervention.
BACKGROUND: Lumbar-flexion-based endurance training, namely cycling, could be effective in reducing pain and improving function and health-related quality of life in older people with chronic low back pain. OBJECTIVES: To assess barriers and facilitators to home-based cycling in older patients with lumbar spinal stenosis (LSS). METHODS: We conducted a retrospective mixed-method study. Patients≥50 years old followed up for LSS from November 2015 to June 2016 in a French tertiary care center were screened. The intervention consisted of a single supervised session followed by home-based sessions of cycling, with dose (number of sessions and duration, distance and power per session) self-determined by patient preference. The primary outcome was assessed by a qualitative approach using semi-structured interviews at baseline and 3 months and was the identification of barriers and facilitators to the intervention. Secondary outcomes were assessed by a quantitative approach and were adherence monitored by a USB stick connected to the bicycle, burden of treatment assessed by the Exercise Therapy Burden Questionnaire (ETBQ) and clinical efficacy assessed by change in lumbar pain, radicular pain, disability, spine-specific activity limitation and maximum walking distance at 3 months. RESULTS: Overall, 15 patients were included and data for 12 were analyzed at 3 months. At baseline, the mean age was 70.9 years (95% CI: 64.9-76.8) and 9/15 patients (60.0%) were women. Barriers to cycling were fear of pain and fatigue, a too large bicycle, burden of hospital follow-up and lack of time and motivation. Facilitators were clinical improvement, surveillance and ease-of-use of the bicycle. Adherence remained stable overtime. The burden of treatment was low [mean ETBQ score: 21.0 (95% confidence interval: 11.5-30.5)]. At 3 months, 7/12 patients (58.3%) self-reported clinical improvement, with reduced radicular pain and disability [mean absolute differences: -27.5 (-43.3 to -11.7), P<0.01 and -17.5 (-32.1 to -2.9), P=0.01, respectively]. CONCLUSIONS: For people with LSS, home-based cycling is a feasible intervention.