Article

Lumbar-flexion-based endurance training, namely cycling, could be
effective in reducing pain and improving function and health-related quality of
life in older people with chronic low back pain. OBJECTIVES: To assess barriers
and facilitators to home-based cycling in older patients with lumbar spinal
stenosis (LSS). METHODS: We conducted a retrospective mixed-method study.
Patients>/=50 years old followed up for LSS from November 2015 to June 2016 in a
French tertiary care center were screened. The intervention consisted of a single
supervised session followed by home-based sessions of cycling, with dose (number
of sessions and duration, distance and power per session) self-determined by
patient preference. The primary outcome was assessed by a qualitative approach
using semi-structured interviews at baseline and 3 months and was the
identification of barriers and facilitators to the intervention. Secondary
outcomes were assessed by a quantitative approach and were adherence monitored by
a USB stick connected to the bicycle, burden of treatment assessed by the
Exercise Therapy Burden Questionnaire (ETBQ) and clinical efficacy assessed by
change in lumbar pain, radicular pain, disability, spine-specific activity
limitation and maximum walking distance at 3 months. RESULTS: Overall, 15
patients were included and data for 12 were analyzed at 3 months. At baseline,
the mean age was 70.9 years (95% CI: 64.9-76.8) and 9/15 patients (60.0%) were
women. Barriers to cycling were fear of pain and fatigue, a too large bicycle,
burden of hospital follow-up and lack of time and motivation. Facilitators were
clinical improvement, surveillance and ease-of-use of the bicycle. Adherence
remained stable overtime. The burden of treatment was low [mean ETBQ score: 21.0
(95% confidence interval: 11.5-30.5)]. At 3 months, 7/12 patients (58.3%)
self-reported clinical improvement, with reduced radicular pain and disability
[mean absolute differences: -27.5 (-43.3 to -11.7), P<0.01 and -17.5 (-32.1 to
-2.9), P=0.01, respectively]. CONCLUSIONS: For people with LSS, home-based
cycling is a feasible intervention.
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