Journal of Orthopedic Research & Physiotherapy Category: Medical Type: Research Article
Osteoporosis School in Primary Health Care-A Pilot Study
- Ann-Charlotte Grahn Kronhed1*
- 1 Rehabvast Vadstena, Local Health Care Services In The West Of Östergötland, Division Of Physiotherapy, Department Of Medical And Health Sciences, Linköping University, Linköping, Sweden
*Corresponding Author:Ann-Charlotte Grahn Kronhed
Rehabvast Vadstena, Local Health Care Services In The West Of Östergötland, Division Of Physiotherapy, Department Of Medical And Health Sciences, Linköping University, Linköping, Sweden
Received Date: Mar 31, 2017 Accepted Date: Oct 02, 2017 Published Date: Oct 16, 2017
An osteoporosis school was introduced as a pilot study in a Swedish primary health care center. Women aged 50 years and over with healed fragility fractures were asked to participate. The aim was to increase awareness amongst the participants and to advise them about life-style and fall prevention strategies to prevent a secondary fragility fracture. The osteoporosis school was scheduled to once a week for eight weeks and included theory and exercise training sessions. Eleven women with mean age 74 years participated. Clinical tests such as back straightening test and balance tests were performed, pain was estimated by the visual analogue scale, and health-related quality of life was measured by the SF-36 questionnaire. Straightening of the back improved 0.6 cm (p<0.05), worst estimated pain decreased from 5.8 to 4.0 (p<0.05), and the SF-36 bodily pain domain improved (p<0.05). The participants completed an average of 7 out of 8 sessions. The exercise training sessions were the most appreciated part of the program.
A recent review indicated that it is unclear whether patient education is beneficial and whether it has a significant and clinically relevant impact on osteoporosis management results, and therefore requires further investigation .
A pilot study with an Osteoporosis school was introduced at Vadstena Primary Health Care Centre (PHCC), Sweden, focusing middle-aged and elderly women with a healed fragility fracture. The aim of the osteoporosis school was to deliver disease-specific information to persons at risk of having a secondary fracture and to advise them about the importance of a healthy life-style and adequate physical activity, and also about ergonomic principles and fall prevention measures to prevent a secondary fracture.
MATERIALS AND METHODS
The participants completed the generic Short Form 36 (SF-36, version I) for assessment of their HRQL. The questionnaire has good reliability and validity [17-20]. The SF-36 version 1 compromises 36 items with two to six response options according to an ordinal scale. Eight health domains were assessed: Physical Function (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Function (SF), Role Emotional (RE), and Mental Health (MH) [17,21]. Two summary scores were calculated from these eight domains: Physical Component Summary (PCS) and Mental Component Summary (MCS) indexes using previously established methods . The SF-36 items were coded, scored and summarized to derive the eight domains. The scores were transformed into a 0-100 scale. Zero indicated the worst possible HRQL and 100 the best . Present pain and the worst pain were estimated by a Visual Analogue Scale (VAS) from 0-10, where 0 indicated no pain and 10 the worst possible pain [22,23].
- 1. The disease osteoporosis and its consequences – a public health problem
- 2. Clinical risk factors for the probability of an osteoporotic fracture (FRAX), diagnosis and treatment
- 3. Anatomy of the skeleton and bone structure, and also the balance system
- 4. Ergonomic aspects of performing daily living activities, and also adequate aid and support (orthoses)
- 5. Self-management with nutritional, physical activity and fall prevention behaviour
- 6. Mindfulness
At the end of the intervention period the participants were offered physical activity on prescription (in Swedish FaR®) to improve their physical activity habits , and they were also introduced to individual or group training program with sequence training equipment at the PHCC gymnasium [36,37].
Participants and drop-outs, attendance
Drugs, fractures and FRAX-values
Back straightening, chair rising, balance performance, handgrip, pain, and health-related quality of life
Significance level p<0.05 is presented as *
|Clinical tests||Mean (SD)||Mean (SD)||n||p|
|Back straightening (C7-wall) (cm)||6.7 (1.5)||6.1 (1.8)||11||0.018|
|Handgrip dominant (kg)||19.4 (7.5)||19.8 (7.0)||11||0.307|
|Handgrip non-dominant (kg)||17.6 (7.8)||17.6 (6.7)||11||0.859|
|Sharpened Romberg, eyes open (s)||23.2 (11.2)||25.2 (9.0)||11||0.225|
|Sharpened Romberg, eyes closed (s)||12.4 (13)||11.7 (12.6)||11||0.917|
|Right leg, eyes open (s)||12.3 (11.9)||13.3 (12.3)||10||0.401|
|Left leg, eyes open (s)||14.4 (14.3)||12.2 (10.6)||10||0.646|
|Right leg, closed eyes (s)||2.5 (4.5)||2.6 (5.6)||10||0.654|
|Left leg, closed eyes (s)||1.4 (2.3)||1.4 (2.3)||10||1|
|Walking forwards (steps)||10.4 (6.9)||11.5 (5.9)||11||0.068|
|Walking backwards (steps)||8.5 (6.9)||9.5 (6.2)||11||0.106|
|Present pain (VAS)||4.7 (2.4)||2.8 (2.7)||11||0.069|
|Worst pain (VAS)||5.8 (3.5)||4.0 (3.4)||10||0.043|
After the intervention period three women joined a strength training group and one woman joined a balance training group at the PHCC. Other participants continued their physical activity by regular walks and home training exercises.
The osteoporosis school was appreciated amongst the women in specific the exercise training sessions, which they told us were the best part of the school. A qualitative study previously confirmed that professionally supervised specific back exercise training may bring benefits to everyday life, increase well-being and quality of life in elderly women with vertebral fractures . Supervised exercise training sessions for bone health and balance performance could be recommended to persons suffering from osteoporosis [23,27,30,41-43]. The back-straightening ability was improved in the present study, which may mean better back muscle function . Estimated pain decreased amongst the participants, which is in accordance with training studies designed for elderly women with osteoporosis and fractures with exercise sessions 45-60 minutes 2-3 times per week for 2.5-6 months [23,41-43]. The improvement in the SF-36 bodily pain domain agrees with a training study for four months . A tendency towards improved balance performance was found in tandem walking forwards in spite of the few scheduled training sessions. In a training study for women with osteoporotic vertebral compression balance performance was improved after exercising two times a week for three months . Five women in the present Osteoporosis school did not manage to stand on one leg with the eyes open for 10 seconds or more, which may mean about 2.6 times increased hip fracture risk according to a study with Swedish elderly women . Mean values for hand grip strength (19.6 kg in the dominant and 17.6 kg in the non-dominant hand) amongst the participants in the present study corresponded to normative mean values in American women aged 75 years and over .
Personal guidance, encouragement, and advice on adequate physical activity are very important to improve bone health, muscle function and balance in elderly women with osteoporosis and fragility fractures [45-46]. The international physical activity guidelines for public health recommend at least 150 min of moderate intensity distributed amongst 5-7 days a week, such as brisk walks for all adults [47,48]. However, elderly women with osteoporotic related fractures should not be forced to walk too fast due to an increased risk of falls . There is a lack of well-designed studies evaluating the effect of education and physical exercise training in women with established osteoporosis [50,51]. osteoporosis and fracture may have a profound impact on physical function and everyday activity. Thus, healthcare professionals and persons with osteoporosis would benefit from more information on how treatments impact patients’ physical function and everyday activity, to optimise treatment decisions and to improve compliance and persistence with treatment to prevent future fractures .
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Citation:Grahn Kronhed AC (2017) Osteoporosis School in Primary Health Care-A Pilot Study. J Orthop Res Physiother 3: 033
Copyright: © 2017 Ann-Charlotte Grahn Kronhed, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.