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- Title
The Clinical Effectiveness of a Physiotherapy Delivered Physical and Psychological Group Intervention for Older Adults With Neurogenic Claudication: The BOOST Randomized Controlled Trial.
- Authors
Williamson, Esther; Boniface, Graham; Marian, Ioana R; Dutton, Susan J; Garrett, Angela; Morris, Alana; Hansen, Zara; Ward, Lesley; Nicolson, Philippa J A; Rogers, David; Barker, Karen L; Fairbank, Jeremy C; Fitch, Judith; French, David P; Comer, Christine; Mallen, Christian D; Lamb, Sarah E; Group, BOOST Research; BOOST Research Group
- Abstract
<bold>Background: </bold>Neurogenic claudication (NC) is a debilitating spinal condition affecting older adults' mobility and quality of life.<bold>Methods: </bold>A randomized controlled trial of 438 participants evaluated the effectiveness of a physical and psychological group intervention (BOOST program) compared to physiotherapy assessment and tailored advice (best practice advice [BPA]) for older adults with NC. Participants were identified from spinal clinics (community and secondary care) and general practice records and randomized 2:1 to the BOOST program or BPA. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data were also collected at 6 months. Other outcomes included ODI walking item, 6-minute walk test (6MWT), and falls. The primary analysis was intention-to-treat.<bold>Results: </bold>The average age of participants was 74.9 years (standard deviation [SD] 6.0) and 57% (246/435) were female. There was no significant difference in ODI scores between treatment groups at 12 months (adjusted mean difference [MD]: -1.4 [95% confidence intervals (CI) -4.03, 1.17]), but, at 6 months, ODI scores favored the BOOST program (adjusted MD: -3.7 [95% CI -6.27, -1.06]). At 12 months, the BOOST program resulted in greater improvements in walking capacity (6MWT MD: 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD: -0.2 [95% CI -0.45, -0.01]) and reduced falls risk (odds ratio: 0.6 [95% CI 0.40, 0.98]) compared to BPA. No serious adverse events were related to either treatment.<bold>Conclusions: </bold>The BOOST program substantially improved mobility for older adults with NC. Future iterations of the program will consider ways to improve long-term pain-related disability. Clinical Trials Registration Number: ISRCTN12698674.
- Subjects
RESEARCH; PHYSICAL therapy; GAIT in humans; RESEARCH methodology; EVALUATION research; TREATMENT effectiveness; COMPARATIVE studies; RANDOMIZED controlled trials; QUALITY of life; WALKING; RESEARCH funding
- Publication
Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 2022, Vol 77, Issue 8, p1654
- ISSN
1079-5006
- Publication type
journal article
- DOI
10.1093/gerona/glac063