title: The boot camp program for lumbar spinal stenosis: a protocol for a randomized controlled trial.
abstract: BACKGROUND
  Lumbar spinal stenosis (LSS) causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. The prevalence of lumbar spinal stenosis is growing rapidly due to an aging population. The dominant limitation in LSS is walking ability. Postural, physical and psychosocial factors can impact symptoms and functional ability. LSS is the most common reason for spine surgery in older adults yet the vast majority of people with LSS receive non-surgical treatment. What constitutes effective non-surgical treatment is unknown. The purpose of this study is to evaluate the effectiveness of a multi-modal and self-management training program, known as the Boot Camp Program for LSS aimed at improving walking ability and other relevant patient-centred outcomes.
  
  
  METHODS
  We will use a pragmatic two-arm randomized controlled single blinded (assessor) study design. Eligible and consenting participants will be randomized to receive from licensed chiropractors either a 6-week (twice weekly) self-management training program (manual therapy, education, home exercises) with an instructional workbook and video and a pedometer or a single instructional session with an instructional workbook and video and pedometer. The main outcome measure will be the self-paced walking test measured at 6 months. We will also assess outcomes at 8 weeks and 3 and 12 months.
  
  
  CONCLUSIONS
  Symptoms and functional limitations in LSS are variable and influenced by changes in spinal alignment. Physical and psychological factors result in chronic disability for patients with LSS. The Boot Camp Program is a 6-week self-management training program aimed at the multi-faceted aspects of LSS and trains individuals to use self-management strategies. The goal is to provide life-long self-management strategies that maximize walking and overall functional abilities and quality of life.
  
  
  BACKGROUND
  ClinicalTrials.gov ID: NCT02592642.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ; Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Carlo
authors.identifier: 0000-0003-4417-4961
authors.initials: C
authors.lastname: Ammendolia
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada ; University of Ontario Institute of Technology, Ontario, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Department of Orthopedics, Toronto Western Hospital, University Health Network, Toronto, Canada.
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.affiliation: Canadian Memorial Chiropractic College, Toronto, Ontario Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Canadian Memorial Chiropractic College, Toronto, Ontario Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Budgell
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada ; Department of Medicine, University of Toronto, Toronto, Ontario Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada ; Department of Medicine, University of Toronto, Toronto, Ontario Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
keywords: Boot camp program; Lumbar spinal stenosis; Multi-modal treatment; Neurogenic claudication; Non-surgical; Randomized controlled trial; Self-management; Walking