Walking Training After Lumbar Decompression Surgery

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.