Life-changing research trials new treatment approach for debilitating spinal condition 

A group of patients with a painful spinal condition are benefiting from a new programme of physiotherapist-led classes thanks to research.

The National Institute for Health and Care Research (NIHR)-funded Better Outcomes for Older People with Spinal Trouble (BOOST) study is testing a strength and conditioning programme to see if it is more effective than standard treatment for people with spinal stenosis.

The group receiving the treatment in North Devon say it has made a big difference to their quality of life, with improvements in physical and mental health and confidence.

Lumbar spinal stenosis is an age-related narrowing of the spinal canal, which places pressure on nerves and blood vessels causing pain and weakness in the lower back, buttocks, or legs. The condition can limit people’s ability to walk and stand and cause pain, which can make it harder to remain independent.

The latest phase of BOOST, which is supported by the NIHR Clinical Research Network South West Peninsula, is running at a number of sites nationwide, including North Devon District Hospital (NDDH), part of Royal Devon University Healthcare NHS Foundation Trust. It is aiming to find out if patients get the same benefit from the programme when it is part of real-world care as they did when it was tested under more controlled conditions – a type of research known as an implementation study.

The team at NDDH recruited 12 people against an original target of 10 to trial the classes, which are delivered by NHS physiotherapists at CrossFit North Devon in Barnstaple.

James Rodger, Consultant Physiotherapist at NDDH is a Principal Investigator for BOOST. He said: “Some people with this condition can be quite vulnerable, struggling to get up from a chair, for example. Normally, physiotherapists would see them around three times as outpatients, and they would be given light repetitive exercise. But this is a series of 12 classes, and the goal is strength and conditioning.

“Basically, it’s quite simple. We’ve also encouraged them to take part in a walking program. I don’t think we’re making major physical changes in the short term, just trying to give the time and confidence to walk. It’s almost a case of giving them permission to try, and see what they can do.

“Seeing how the intervention works in practice has challenged my beliefs. I actually expected less progress but they have really improved a lot in a short time. The study has had a significant cultural change on how classes are delivered for this group and others, and the team are moving forward to reflect this in class delivery.

“The setting has worked really well, and we’ve found they really like the class environment. One of our participants is now even considering starting Crossfit, aged 72.”

BOOST is sponsored by the University of Exeter, and conducted by a study team led by Professor Sallie Lamb, Pro-Vice Chancellor of the University’s Faculty of Health and Life Sciences. Professor Lamb said: “I am delighted to hear that the BOOST programme has had such a positive effect on this group of patients, benefiting them both physically and mentally. Spinal conditions can have a huge impact on quality of life, and finding ways to improve treatment can make a real difference. The BOOST project forms part of a body of world-leading research into rehabilitation here at Exeter, of which we are incredibly proud.”

BOOST volunteer Pam Lee from Barnstaple said: “I think this has made us all more motivated to try and extend what we can do. For some people it has also just been a reason to get out of the house. Mentally and physically I think it’s been great, and there is a competitive element that has really motivated some of us.

“I’ve tried normal physio and it didn’t seem to do much for me, but with this I feel I’m getting better. I can walk a lot further than I could before.”

Sue Smith from North Cornwall added: “The improvement in my balance has been really amazing. Taking part in the trial has helped me feel more confident in myself.”

Arie Hollenbach from Barnstaple said: “This has made a big difference to me. I’m walking further now and not seizing up as much. It’s meant spending time and working in my allotment has become much more relaxing, and easier.”

Ann Oakley from Barnstaple felt the social benefits of the classes were also significant: “It has been fantastic to meet other people and get out and do something, it has done so much for me mentally. It’s helped me accept my situation and what I can and can’t do.

“The fact that everyone in the class has the same condition is really nice. I’ve seen the expressions on people’s faces change, from a bit miserable to really happy.”