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The Boot Camp treatment program for patients with lumbar spinal stenosis in Danish chiropractic care-a feasibility
Rikke Krüger Jensen1,2, Lisbeth Hartvigsen3, Berit Schiøttz-Christensen4
1Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. rikkekruger@kiroviden.sdu.dk.
Background:
Lumbar spinal stenosis (LSS) affects older people, leading to a decline in functional ability, and its prevalence is projected to rise with the aging population. Effective, affordable, and low-risk interventions are needed to maintain the function and quality of life for LSS patients. This study tested the feasibility of implementing a comprehensive conservative treatment program (Boot Camp Program) for LSS in Danish chiropractic clinics to inform a future randomised clinical trial. The objectives were to assess feasibility in terms of recruitment, adherence, data collection procedures, and completeness of outcomes, and to describe patient characteristics and investigate changes in outcomes over time.
Method:
Using a prospective, single-arm, pretest-posttest design, this study sought to recruit 50 patients with LSS from six chiropractors in two primary care chiropractic practices. The program consisted of 12 visits and included patient education, manual therapy, and a progressive home exercise program. The impact of the program was assessed by measuring walking distance using a treadmill test at the 6- and 12-week follow-ups visits and self-reported pain and physical function at 6-, 12-, 20-, and 52-week intervals.
Results:
In total, 147 patients were screened for eligibility and 38 (26%) were included. The mean age was 69 years (SD 10, range 47-89) and 61% were women. Thirty-four (90%) completed the 6-week program and 32 (84%) provided follow-up data. Almost 80% completed one daily exercise session 5 to 7 days a week. Overall, data collection procedures were feasible, except for paper patient diaries. Follow-up rates at 12, 20, and 52 weeks were 87%, 82%, and 74% respectively. Participants improved their walking distance on average by 45% and 53% at 6 and 12 weeks, respectively. Clinically relevant improvement was observed in secondary outcomes such as leg pain, back pain, and physical function at all follow-ups.
Conclusions:
The Boot Camp Program for LSS was feasible to deliver in Danish chiropractic practice and patients improved on relevant outcomes. However, the recruitment procedure was ineffective. Logistics, awareness, incentives, timeframes, and patient motivation may have influenced enrolment and adherence. Recruitment in multiple settings and patient enrolment incentives will be considered.
