Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections

Abstract

Purpose of review: The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit.

Recent findings: Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group. Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.

Keywords: Elderly; Epidural steroid injections; Lumbar stenosis and radicular pain; Short physical performance battery (SPPB).

Fig 1.

Injection versus medical management group differences in mean change between pre- and post-intervention in (A) Short Physical Performance Battery (SPPB) total scores. (B) 4-meter walk test time (C), chair stand time (D), balance scores, and (E) pain scores for injection and medication management groups. Error bars represent standard error. An asterisk (*) indicates significant (P < 0.05, Wilcoxon signed rank tests) group differences between pre- and post-intervention within either injection or medication management group. Pound sign (#) indicates significant (P < 0.05, Mann-Whitney U test, Table 3) baseline differences injection or medication management group.

Fig 2.

Percent change between pre- and post-intervention in (A) Short Physical Performance Battery (SPPB) total scores. (B) 4-meter walk test time (C), chair stand time (D), balance scores, and (E) pain scores for injection and medication management groups.