A Summary of Facilitators and Barriers to Physical Therapy Engagement for Older Adults With Lumbar Spinal Stenosis: A Scoping Review

Background and Purpose: Lumbar spinal stenosis (LSS) is a common spine disease in older adults leading to mobility limitations and decreased quality of life. Physical therapy (PT) is effective at improving pain and function for patients with LSS. However, PT utilization remains low contributing to higher surgical rates. Compared to PT, surgery is associated with greater medical risk and health care costs. The purpose of this scoping review is to identify facilitators and barriers to PT engagement among older adults with LSS with the aim of understanding PT underutilization and reducing unnecessary surgical interventions. Methods: Two independent reviewers searched 3 databases, PubMed, CINAHL (EBSCO), and PEDro. Inclusion criteria were the following: observational (prospective or retrospective), experimental (randomized and nonrandomized controlled trials, prospective clinical trials, and cohort studies) and qualitative studies published in English; adults ages 60 years and older with LSS; evidence of PT utilization; and outcomes of facilitators and/or barriers. Thematic analysis was used to categorize facilitators and barriers extracted from included studies. Results and Discussion: Of 332 studies, 8 remained following screening of titles, abstracts, and full texts. A total of 392 patients were included across studies. Six themes were identified for both, facilitators and barriers. Facilitators included flexible clinic scheduling and accessibility, personalized patient education, and positive social support. Barriers included unreliable transportation, high cost, symptoms from a medical condition(s), and excessive travel and time. Patient-centered factors, patient-provider relationship, and delivery of care were categorized as both facilitators and barriers. Facilitators and barriers identified for patients with LSS align with those previously identified for other musculoskeletal conditions. Conclusion: This scoping review is the first to identify facilitators and barriers influencing PT engagement for patients with LSS. It is imperative that clinicians consider facilitators and barriers in addition to patient-specific needs to optimize engagement in PT and maximize mobility and health for patients with LSS. Future research should focus on other potential factors impacting PT engagement such as health care practitioner referrals to PT.