Implementation of a Non-Operative, Non-Pharmacological Lumbar Spinal Stenosis Clinic at a Single VA Medical Center.

BACKGROUND: Lumbar spinal stenosis (LSS), prevalent among older adults, causes debilitating back and/or leg pain during ambulation. Declining physical fitness, increased risk of falls, and unintended consequences of analgesic medications compound LSS-related health concerns. Recent clinical studies described using a structured comprehensive training program and manual therapy/individualized exercises to achieve effective and safe management of LSS. Here we describe a clinical demonstration project that implemented an LSS clinic in a real-world clinical setting. PARTICIPANTS AND SETTING: Patients referred to the LSS clinic at a Veterans Affairs (VA) medical center from January through December 2024. METHODS: The LSS clinic delivered a biopsychosocial multi-modal rehabilitative program that included 12 visits over 6 weeks. We assessed two patient-reported outcomes: Pain, Enjoyment, and General Activity Scale (PEG-3) and Patient Specific Functional Scale (PSFS); and three performance-based outcomes: 6-min walk test (6MWT), 5-times sit to stand test (5XSST), and daily steps. RESULTS: Of the 67 patients who were clinically appropriate for the LSS clinic, 64 (96%) were male and had a mean age of 73.9 ± 8.2 years. Among those, 42 (63%) completed ≥ 9 visits (mean 11.7 ± 0.7 visits) while the remaining 25 (37%) completed eight or fewer visits (mean 3.1 ± 3.1 visits). Patients who completed ≥ 9 visits had significant within-group improvements in the PEG-3 (6.2 vs. 4.2, p < 0.001), PSFS (3.7 vs. 5.9, p < 0.001), 6MWT (879 vs. 1118 ft, p < 0.001), 5XSST (20.4 vs. 13.5 s, p < 0.001), and daily steps (3434 vs. 4306 steps; p < 0.05). CONCLUSIONS: Outcomes indicate successful implementation of the LSS clinic at a single VA medical center. Veterans who completed ≥ 9 visits achieved clinically meaningful changes in patient-reported and performance-based outcomes. Dissemination of the LSS clinic to additional VA medical centers has strong potential to improve function and enhance the quality of life for other Veterans.