Problem areas identified as important to older adults with lumbar spinal stenosis

Abstract

Background context: There is growing concern that patient-reported outcomes (PROs) commonly used in clinical research evaluating treatments such as epidural steroid injections (ESIs) for lumbar spinal stenosis may not adequately capture outcomes of greatest importance to older adults.

Purpose: The purpose of the study was to determine what outcomes are most important to older adults with spinal stenosis, how well commonly used PROs reflect what is most important to these participants, and which outcomes older adults with spinal stenosis would want improved to consider having ESI.

Study design/setting: This is an outcome prioritization study.

Patient sample: Community sample of 33 older adults with spinal stenosis were included.

Outcome measures: The outcome measures were Swiss Spinal Stenosis Questionnaire and Roland-Morris Disability Questionnaire.

Methods: The methods involve individual sorting and ranking exercises followed by facilitated focus groups.

Results: Highest rated problem areas were "experiencing pain/discomfort" (88% of participants), "problems with physical function" (85%), "difficulty exercising" (73%), "difficulty participating in hobbies and leisure activities" (55%), and "problems with weakness" (52%). Only 10 of the 24 Roland-Morris Disability Questionnaire items were rated by 50% or more of participants experiencing them as important enough to warrant ESI treatment.

Conclusions: Older adults with spinal stenosis rated problems related to pain and physical function as the most important outcomes to them. However, difficulty exercising and difficulty participating in hobbies and leisure activities were also among the most highly rated and were two areas not typically assessed in treatment studies. Commonly used PROs in spinal stenosis treatment studies may be insufficient to comprehensively assess outcomes from the patient perspective.

Keywords: Epidural steroid injections; Lumbar spinal stenosis; Outcomes; Patient centered; Prioritization; Treatment.