The effectiveness and safety of nonsurgical integrative interventions for symptomatic lumbar spinal spondylolisthesis: A randomized controlled multinational, multicenter trial protocol

Kiok Kim, Yousuk Youn, Sang Ho Lee, Jung Chul Choi, Jae Eun Jung, Jaehong Kim, Wenchun Qu, Jason Eldrige, Tae-Hun Kim, Kiok Kim, Yousuk Youn, Sang Ho Lee, Jung Chul Choi, Jae Eun Jung, Jaehong Kim, Wenchun Qu, Jason Eldrige, Tae-Hun Kim

Abstract

Background: Surgery is generally accepted as the main therapeutic option for symptomatic lumbar spondylolisthesis. However, new nonsurgical therapeutic options need to be explored for this population.

Objectives: The objective of this study is to assess the effectiveness and safety of a 5-week Mokhuri treatment program compared with conventional nonsurgical treatments for symptomatic lumbar spondylolisthesis.

Methods: This is a study protocol for a multinational, multicenter clinical randomized controlled trial comparing the effectiveness and safety of 5 weeks of nonsurgical integrative treatments (a Mokhuri treatment program consisting of Chuna, acupuncture, and patient education) with nonsurgical conventional treatments (drugs for pain relief, epidural steroid injections, and physical therapy). Clinical outcomes including visual analogue scale (VAS) scores ranging from 0 to 100 for low back pain and leg pain, EQ-5D scores, Oswestry disability index (ODI) scores, Roland-Morris Disability Questionnaire (RMDQ) scores, Zurich Claudication Questionnaire (ZCQ) scores, walking duration and distance without leg pain, and a 5-minute treadmill test, and the ratio between the actual duration of participation and the originally scheduled duration in each group, the presence of any additional spondylolisthesis treatments, the types of concomitant treatments during the follow-up period, and adverse events (AEs) will be assessed at 7 weeks, 18 weeks, 30 weeks, 54 weeks, and 102 weeks after the end of the treatments.

Conclusion and discussion: The results of this study will provide clinical evidence on nonsurgical integrative interventions for patients with symptomatic lumbar spondylolisthesis. CLINICAL TRIAL REGISTRY:: clinicaltrials.gov (NCT03107468).

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. Kalichman L, Kim DH, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976) 2009;34:199.
    1. Matz PG, Meagher RJ, Lamer T, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 2016;16:439–48.
    1. Alfieri A, Gazzeri R, Prell J, et al. The current management of lumbar spondylolisthesis. J Neurosurg Sci 2013;57:103–13.
    1. Chung N-S, Jeon C-H. Surgical treatment of degenerative and isthmic spondylolisthesis. J Korean Spine Surg 2009;16:228–34.
    1. Martin BI, Mirza SK, Comstock BA, et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine (Phila Pa 1976) 2007;32:382–7.
    1. Steiger F, Becker HJ, Standaert CJ, et al. Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review. Eur Spine J 2014;23:945–73.
    1. Park HS, Kim MC, Kim SY, et al. Korean medical treatment for improving symptoms of four patients diagnosed with grade II lumbar spondylolisthesis. Acupuncture 2014;31:153–63.
    1. Kim K, Jeong Y, Youn Y, et al. Non-surgical treatment for patients with spondylolisthesis: a retrospective case series. Integr Med Res 2015;4:86.
    1. Kim K, Shin K-M, Lee J-H, et al. Nonsurgical Korean integrative treatments for symptomatic lumbar spinal stenosis: a three-armed randomized controlled pilot trial protocol. Evid Based Complement Alternat Med 2016;2016: 2913248.
    1. Kim M-H, Cho Y-S, Uhm W-S, et al. Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res 2005;14:1401–6.
    1. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 2005;43:203–20.
    1. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine 2000;25:2940–53.
    1. Jeon C-H, Kim D-J, Kim S-K, et al. Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci 2006;21:1092–7.
    1. Lee JS, Lee DH, Suh KT, et al. Validation of the Korean version of the Roland–Morris disability questionnaire. Eur Spine J 2011;20:2115–9.
    1. Roland M, MoRRISR A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 1983;8:145–50.
    1. Stucki G, Daltroy L, Liang MH, et al. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976) 1996;21:796–803.
    1. Pratt RK, Fairbank JC, Virr A. The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 2002;27:84–91.
    1. Koc Z, Ozcakir S, Sivrioglu K, et al. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976) 2009;34:985–9.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–58.
    1. Tallarico RA, Madom IA, Palumbo MA. Spondylolysis and spondylolisthesis in the athlete. Sports Med Arthrosc Rev 2008;16:32–8.
    1. Susukida R, Crum RM, Ebnesajjad C, et al. Generalizability of findings from randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network. Addiction 2017;112:1210–9.

Source: PubMed

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