Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review

Dusdal, Kim; Grundmanis, J.; Luttin, Kathryn; Ritchie, Phyllis; C, Rompre; Sidhu, Rawel; Harris, Susanna

doi:10.1007/s00198-010-1497-6

Cited by 30 publications

(15 citation statements)

References 45 publications

(137 reference statements)

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“…Exercises to improve muscle strength need to focus on the back extensors. The exercises of back extensors may decrease kyphosis, lead to better dynamic static posturing, reduce pain and subsequently increase mobility and improve the patient's quality of life . For this reason, we commenced a rehabilitation program including muscle strengthening, range of motion and relaxation exercises as well as weight‐bearing exercises in both cases.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy‐associated osteoporosis presenting severe vertebral fractures

Öztürk

Atamaz

Akkurt

et al. 2013

J of Obstet and Gynaecol

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The syndrome of pregnancy-associated osteoporosis (PAO) is a rare disorder which occurs either in late pregnancy or early post-partum period leading to fragility fracture(s), most commonly in the vertebral bodies. We presented two cases with PAO who had compression fractures at multiple levels involving five vertebrae in one case and 10 vertebrae in the other. Their spinal bone mineral density values were below -2.5 standard deviations. Anti-osteoporotic treatments with nasal calcitonin 400 IU/day, vitamin D 300.000 IU single dose, calcium 1000 mg/day, vitamin D 880 IU/day were initiated. In one case, kyphoplasty was performed by a spinal surgeon. In addition to a thoracolumbosacral orthosis, a rehabilitation program including muscle strengthening, range of motion, relaxation and weight-bearing exercises was started for both cases. These cases emphasize that all pregnant women with complaints of back/lumbar pain should be carefully evaluated.

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Section: Discussionmentioning

confidence: 99%

Pregnancy‐associated osteoporosis presenting severe vertebral fractures

Öztürk

Atamaz

Akkurt

et al. 2013

J of Obstet and Gynaecol

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“…The strength training dose is consistent with those in previous studies. 26,28, [57][58][59] Intensity. Participants will be asked to perform aerobic exercise at an intensity of 5 to 8 on the Borg Rating of Perceived Exertion Scale.…”

Section: Setting and Supervisionmentioning

confidence: 99%

Build Better Bones With Exercise: Protocol for a Feasibility Study of a Multicenter Randomized Controlled Trial of 12 Months of Home Exercise in Women With a Vertebral Fracture

Giangregorio

Thabane

Adachi³

et al. 2014

Physical Therapy

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“…It is also notable that only one study included any male subjects; this point is emphasised in the reviews by Giangregorio et al 40 and Dusdal et al 123…”

Section: Multimodal Interventionsmentioning

confidence: 99%

Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT

Barker

Newman

Stallard

et al. 2019

Health Technol Assess

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Background A total of 25,000 people in the UK have osteoporotic vertebral fracture (OVF). Evidence suggests that physiotherapy may have an important treatment role. Objective The objective was to investigate the clinical effectiveness and cost-effectiveness of two different physiotherapy programmes for people with OVF compared with a single physiotherapy session. Design This was a prospective, adaptive, multicentre, assessor-blinded randomised controlled trial (RCT) with nested qualitative and health economic studies. Setting This trial was based in 21 NHS physiotherapy departments. Participants The participants were people with symptomatic OVF. Interventions Seven sessions of either manual outpatient physiotherapy or exercise outpatient physiotherapy compared with the best practice of a 1-hour single session of physiotherapy (SSPT). Main outcome measures Outcomes were measured at 4 and 12 months. The primary outcomes were quality of life and muscle endurance, which were measured by the disease-specific QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis – 41 items) and timed loaded standing (TLS) test, respectively. Secondary outcomes were (1) thoracic kyphosis angle, (2) balance, evaluated via the functional reach test (FRT), and (3) physical function, assessed via the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), Physical Activity Scale for the Elderly, a health resource use and falls diary, and the EuroQol-5 Dimensions, five-level version. Results A total of 615 participants were enrolled, with 216, 203 and 196 randomised by a computer-generated program to exercise therapy, manual therapy and a SSPT, respectively. Baseline data were available for 613 participants, 531 (86.6%) of whom were women; the mean age of these participants was 72.14 years (standard deviation 9.09 years). Primary outcome data were obtained for 69% of participants (429/615) at 12 months: 175 in the exercise therapy arm, 181 in the manual therapy arm and 173 in the SSPT arm. Interim analysis met the criteria for all arms to remain in the study. For the primary outcomes at 12 months, there were no significant benefits over SSPT of exercise [QUALEFFO-41, difference –0.23 points, 95% confidence interval (CI) –3.20 to 1.59 points; p = 1.000; and TLS test, difference 5.77 seconds, 95% CI –4.85 to 20.46 seconds; p = 0.437] or of manual therapy (QUALEFFO-41, difference 1.35 points, 95% CI –1.76 to 2.93 points; p = 0.744; TLS test, difference 9.69 seconds (95% CI 0.09 to 24.86 seconds; p = 0.335). At 4 months, there were significant gains for both manual therapy and exercise therapy over SSPT in the TLS test in participants aged < 70 years. Exercise therapy was superior to a SSPT at 4 months in the SPPB, FRT and 6MWT and manual therapy was superior to a SSPT at 4 months in the TLS test and FRT. Neither manual therapy nor exercise therapy was cost-effective relative to a SSPT using the threshold of £20,000 per quality-adjusted life-year. There were no treatment-related serious adverse events. Conclusions This is the largest RCT to date assessing physiotherapy in participants with OVFs. At 1 year, neither treatment intervention conferred more benefit than a single 1-hour physiotherapy advice session. The focus of future work should be on the intensity and duration of interventions to determine if changes to these would demonstrate more sustained effects. Trial registration Current Controlled Trials ISRCTN49117867. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 44. See the NIHR Journals Library website for further project information.

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Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review

Cited by 30 publications

References 45 publications

Pregnancy‐associated osteoporosis presenting severe vertebral fractures

Pregnancy‐associated osteoporosis presenting severe vertebral fractures

Build Better Bones With Exercise: Protocol for a Feasibility Study of a Multicenter Randomized Controlled Trial of 12 Months of Home Exercise in Women With a Vertebral Fracture

Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT

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