Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists.
BACKGROUND
Neurogenic claudication (NC) is the clinical syndrome commonly associated with lumbar spinal stenosis (LSS). Non-surgical management is recommended as initial treatment, but little is known about current practice in relation to the assessment and management of these patients in the non-surgical setting.


METHODS
We conducted a questionnaire survey of physiotherapists in a large UK primary care musculoskeletal service which provides a city-wide multidisciplinary assessment and treatment facility for patients with spinal and other musculoskeletal problems. Data on therapists' recognition and management of patients with NC and LSS were collected.


RESULTS
Fifty out of 54 therapists completed questionnaires, and all but one of these identified a clearly recognised posture-related clinical syndrome of NC. Almost all respondents (48: 96%) reported the routine use of physiotherapy treatments. In particular, advice and education (49: 98%) along with an exercise programme (47: 94%) incorporating flexion-based exercises (41: 82%) and trunk muscle stabilising exercises (35: 70%) were favoured.


CONCLUSIONS
Musculoskeletal physiotherapy clinicians in this survey recognised a clear clinical syndrome of NC, based on the findings of posture-dependent symptoms. Most therapists reported the routine use of flexion-based exercise, reflecting recommendations in the literature which are based on theoretical benefits, but for which trial evidence is lacking. There is a need for research evidence to guide the choice of physiotherapy treatments.
Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, LS7 4SA, UK. c.comer@nhs.net
Christine M
CM
Comer
Anthony C
AC
Redmond
Howard A
HA
Bird
Philip G
PG
Conaghan
D003625:Data Collection / Q000706:statistics & numerical data; D019468:Disease Management; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007383:Intermittent Claudication / Q000453:epidemiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D026201:Musculoskeletal Manipulations / Q000379:methods* / Q000706:statistics & numerical data; D026761:Physical Therapy Specialty / Q000379:methods / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D013130:Spinal Stenosis / Q000453:epidemiology / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology