Walking Training After Lumbar Decompression Surgery
Effectiveness of Task-Specific Gait Training After Lumbar Decompression: An Assessor-Blinded Randomized Controlled Trial
This study will test whether adding walking practice to standard rehabilitation improves balance while walking after lower back surgery. The study will include 60 adults aged 30 to 65 who still have difficulty walking or keeping their balance after surgery to relieve pressure on the nerves in the lower back caused by a narrowing of the spinal canal.
Participants will be assigned by chance to one of two groups. One group will receive standard rehabilitation. The other group will receive the same rehabilitation plus extra practice with everyday walking tasks, such as changing speed, turning, and stepping over obstacles. Both groups will attend three supervised sessions per week for eight weeks.
Participants will be assessed before starting the program and again at weeks 4 and 8. The person who performs the assessments will be unaware of each participant's group assignment. The main outcome is balance during walking tasks at week 8. The study will also assess walking speed and distance, the ability to get up from a chair and move around, back and leg pain, and how back problems affect daily activities.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
This is an assessor-blinded, parallel-group randomized controlled trial in adults with persistent walking or balance difficulties after lumbar decompression without fusion for lumbar spinal stenosis. Baseline assessments will take place 6 to 12 weeks after surgery, before randomization. Participants will be assigned in a 1:1 ratio to standard rehabilitation or standard rehabilitation plus task-specific gait training.
The additional training will be progressed according to each participant's ability to complete the walking tasks safely and without a marked increase in symptoms. The comparison will estimate the effect of adding the training program to standard rehabilitation, including the additional exercise time and therapist contact.
The primary analysis will compare Functional Gait Assessment (FGA) total scores at week 8 between groups, adjusting for baseline FGA scores. Weeks 4 and 8 are measured from the start of the rehabilitation program. Week 4 assessments are exploratory. Adverse events will be monitored and documented throughout the intervention period.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: MEHMET SALİH TAN, PhD
- Numéro de téléphone: +90 546 726 68 76
- E-mail: mstan@medipol.edu.tr
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Age 30-65 years, inclusive.
- Primary lumbar decompression without fusion for lumbar spinal stenosis.
- Baseline assessment 6-12 weeks after surgery.
- Surgeon clearance for exercise and physical performance testing.
- Self-reported walking difficulty and at least one walking-task limitation documented at screening.
- Able to walk at least 10 meters without another person's physical assistance, with or without a walking aid.
- Able to understand test instructions.
- Agrees to the 8-week program and all 3 assessments.
- Provides written informed consent.
Exclusion Criteria:
- Spinal fusion or instrumentation at decompression, or revision surgery in the same lumbar region.
- Active wound infection, ongoing cerebrospinal fluid leak, or a postoperative complication preventing exercise.
- Progressive neurological deficit, signs of cauda equina syndrome, or need for surgical reassessment.
- Neurological condition that independently affects walking, such as stroke, Parkinson disease, multiple sclerosis, or significant peripheral neuropathy.
- Advanced hip or knee disease, recent lower-limb fracture, or major lower-limb surgery that substantially affects walking.
- Uncontrolled vestibular disorder or severe uncorrected visual impairment.
- Cardiovascular, pulmonary, or systemic disease that a physician considers a contraindication to exercise or testing.
- Active malignancy, spinal infection, or acute vertebral fracture.
- Concurrent structured gait and balance rehabilitation.
- Pregnancy.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Comparateur actif: Standard Rehabilitation
Participants will receive approximately 40 minutes of supervised standard rehabilitation per session, three times per week for eight weeks. They will also receive the standard home exercise program. |
The supervised program includes a warm-up, trunk control exercises, lower-limb strengthening, flexibility and mobility exercises, comfortable walking on a level and unobstructed surface, and a cool-down. Exercises are individualized according to postoperative restrictions, symptoms, and movement quality. Both groups receive the same home program, which takes approximately 15 to 20 minutes and is performed three days per week. |
|
Expérimental: Standard Rehabilitation Plus Task-Specific Gait Training
Participants will receive the same supervised standard rehabilitation and home exercise program as the active comparator group. Each supervised session will also include approximately 20 minutes of task-specific gait training, for a total of approximately 60 minutes per session, three times per week for eight weeks. |
The supervised program includes a warm-up, trunk control exercises, lower-limb strengthening, flexibility and mobility exercises, comfortable walking on a level and unobstructed surface, and a cool-down. Exercises are individualized according to postoperative restrictions, symptoms, and movement quality. Both groups receive the same home program, which takes approximately 15 to 20 minutes and is performed three days per week. The additional supervised training includes starting and stopping, changing walking speed and step length, turning, side-stepping, and stepping over obstacles. Tasks progress from individual skills to courses that combine multiple walking tasks. Difficulty is adjusted according to each participant's ability to complete the tasks safely and without a marked increase in symptoms. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Functional Gait Assessment (FGA) Total Score at Week 8
Délai: Week 8 after the start of the rehabilitation program
|
The Functional Gait Assessment evaluates balance during 10 walking tasks. Each item is scored from 0 to 3, yielding a total score from 0 to 30. Higher scores indicate better walking balance. The primary analysis will compare week 8 scores between groups, adjusting for baseline FGA scores. |
Week 8 after the start of the rehabilitation program
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Timed Up and Go (TUG) Test Time
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Time in seconds to rise from a chair, walk 3 meters, turn, walk back, and sit down. The mean of two timed trials will be used. Shorter times indicate better functional mobility. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Comfortable Walking Speed on the 10-Meter Walk Test
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Walking speed at a self-selected comfortable pace, measured in meters per second over the middle 10 meters of a 14-meter walkway. The mean speed from two timed trials will be used. Higher values indicate faster walking. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Fast Walking Speed on the 10-Meter Walk Test
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Walking speed at the fastest safe pace without running, measured in meters per second over the middle 10 meters of a 14-meter walkway. The mean speed from two timed trials will be used. Higher values indicate faster walking. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Six-Minute Walk Test Distance
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Total distance walked in six minutes on a level 30-meter corridor, recorded in meters. The clock continues during rest breaks. Greater distance indicates better walking capacity. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Five Times Sit-to-Stand Test Time
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Time in seconds from the start command to reaching full standing on the fifth repetition. The mean of two timed trials will be used. Shorter times indicate better sit-to-stand performance. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Oswestry Disability Index (ODI) Score
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
A 10-section questionnaire assessing how low back problems affect daily activities. Each section is scored from 0 to 5, and the total is expressed as a percentage from 0% to 100%. Higher scores indicate greater disability. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Low Back Pain Intensity on the Numeric Rating Scale (NRS)
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Participant-reported average low back pain intensity over the past 24 hours, rated from 0 (no pain) to 10 (worst pain imaginable). Higher scores indicate greater pain intensity. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
|
Leg Pain Intensity on the Numeric Rating Scale (NRS)
Délai: Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Participant-reported average leg pain intensity over the past 24 hours, rated from 0 (no pain) to 10 (worst pain imaginable). Higher scores indicate greater pain intensity. |
Baseline before the rehabilitation program and weeks 4 and 8 after the start of the program
|
Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Functional Gait Assessment (FGA) Total Score at Week 4
Délai: Week 4 after the start of the rehabilitation program
|
Exploratory assessment of walking balance using the 10-item Functional Gait Assessment. Total scores range from 0 to 30, with higher scores indicating better walking balance. |
Week 4 after the start of the rehabilitation program
|
Collaborateurs et enquêteurs
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Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
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Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- IMU-LD-GAIT-2026
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
There is no current plan to share individual participant data. Any future request would be considered on a case-by-case basis, subject to applicable ethics, institutional, and data protection requirements.
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