Osteoporosis, Vertebral Fracture
Conditions
Keywords
randomized controlled trial, osteoporosis, moderate-intensity circuit exercises, balance, health-related quality of life
Brief summary
The aim of this randomized controlled trial is to evaluate the effectiveness for health-related quality of life (HRQOL) of a 3-month course of exercises for a group of postmenopausal women with osteoporosis who has at least one vertebral fracture versus a control group (undertaking their usual activities). The course of exercises is devised in accordance with methods recommended in Rehabilitation treatment guidelines in postmenopausal and senile osteoporosis.
Detailed description
Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. Apart from its personal and human cost, osteoporosis is a major public health problem, which has an enormous social and economic impact. Osteoporosis(OP) is a common condition among older people,and a non-fatal condition that leads more to changes in the quality of life than to change in the length of life. Osteoporosis is a skeletal disorder characterized by decreased bone mass. The World Health Organization (WHO) Study Group on Osteoporosis has defined osteoporosis as a hip BMD level of more than 2.5 SDs below the mean BMD for young, white, adult women. Using the WHO definition, approximately 30% of postmenopausal women have osteoporosis. The most common consequences of osteoporosis are fractures. Furthermore the most common conditions associated with osteoporosis are back pain, limitations in physical functioning, and psychosocial impairment. Thus, the purpose of this study is to record the effect of the programme on mobility, balance, the disease-specific and generic health-related quality of life for women with osteoporosis and a history of vertebral fractures. The programme consist of a three-hour educational session and a three-month course of exercises in accordance with guidelines for women with an increased risk of falls and postmenopausal osteoporotic women with a history of fractures. Our hypothesis that a three-month course of exercises and a three-hour lesson on how to cope with osteoporosis will have a significantly positive effect on the generic and disease-specific quality of life, as well as the balance and mobility, of elderly (≥60 years) women with postmenopausal osteoporosis and a history of vertebral fractures, both 3 months after the intervention and after one year. The sample would be recruited from the Osteoporosis Outpatient clinic at the Ostfold Hospital, Norway and they their body mineral density (BMD) has been measured using Dual-Energy X-Ray Absorptiometry (DXA). The design of the study is a randomized controlled trial and the sample would be randomized to an intervention group or a control group. Subjects in the control group are asked to maintain their current lifestyle. No restrictions are placed on their exercise activities. Subjects in the intervention group must participate in a training course consisted of 24 sessions over 3 months. The exercises include aerobic, stretching, balance and functional training, i.e. circuit exercises focus been on: the prevention of falls and fractures, improving balance and coordination, improving posture, and informing subjects about risk factors for falls and for osteoporosis and fractures. A 3-hour session of information and supervision will be hold for the intervention group by the same physiotherapist who leads the training sessions. The focus is on body awareness and ergonomic advice in specific, daily-life situations (e.g. lifting/carrying, resting positions).
Interventions
OTHERExercise group
Weekly exercises
OTHERControl Group
No Intervention, control group only
Sponsors
Norwegian Fund for Postgraduate Training in Physiotherapy
Ostfold Hospital Trust
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* women * living at home * ambulatory * aged 60 or more * clinical diagnosis of osteoporosis * a history of vertebral fracture
Exclusion criteria
* recent vertebral fractures * unable to complete the questionnaires * major cognitive impairment (MMSE) ( MMS \< 23 )
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time Used to Walk 20 m at Maximal Speed. | At baseline, 3 and 12 months after the baseline | Times (measured in seconds) used walking at maximum speed for 20m indoors. No acceleration or deceleration phase used. The type of walking aids used during the test will be recorded. The participants walk as fast as possible wearing their ordinary shoes. The test perform once, the time measured with a stopwatch and the time used on 20 m will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Timed Up & Go Test (TUG) | At baseline, 3 and 12 months after the baseline. | The subject will be instructed to rise from a chair with a seat height of 43 cm, walk 3 m, turn around, return and sit down again, wearing ordinary footwear and use customary walking aids if necessary. |
| Functional Reach | At baseline, 3 and 12 months after the baseline | The maximum distance in centimetres that can be reached forward in a standing position while maintaining a fixed base of support. Subjects will be instructed to stand sideways against a wall in a natural position and stretch one arm forward level with the shoulder. The position of the third metacarpophalangeal (MCP) joint was taken as the zero point. With the body tilted forward as far as possible, the subjects continued to stretch the arm parallel to the ground. Amount of cm indicate better balance. |
| QUALEFFO 41 | At baseline, 3 and 12 months after the baseline | Quality of Life Questionnaire issued by the European Foundation for Osteoporosis (QUALEFFO-41), is a disease-specific questionnaire to be used by patients with vertebral fractures attributed to osteoporosis. QUALEFFO-41 is self-administered and contains questions in five domains: pain, ability to perform physical functions, social functioning, general health perception and mental performance. These five domains can be evaluated individually or be represented in a total score. All scores in all the domains are expressed in values ranging from 0-100, where 0 represents the best and 100 the worst. The total QALEFFO score is calculated as a sum of all answers to items and then linearly transformed on the scale 0-100. High scores indicate poor quality of life. |
| General Health Questionnaire 20 (GHQ20). | At baseline, 3 and 12 months after baseline | GHQ-20 is a generic instrument and registers distress and psychopathology. GHQ-20 is self-administered and the answers to each item may be treated as a Likert Scale and have weights assigned to each position (0-1-2-3) where 0 is no distress, and 3 is severe distress. This gives a possible range for the total GHQ-20 score of 0-60. Higher scores indicating poor qol. |
| Falls-Efficacy Scale-International | Baseline, 3 months follow-up, 12 months follow up | A 16- item self report or interview- based questionnaire assessing the fear of falling during basic and more demanding activities of daily living (Yardley et al. 2005). Each item is scored on a four point scale. Minimun score indicating low concern about falling is 16. The maximun score indication high concern about falling is 64. |
Countries
Norway
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Exercise Group : Subjects in the intervention group must participate in a training course consisted of 24 sessions over 3 months. The exercises include aerobic, stretching, balance and functional training, i.e. circuit exercises focus been on: the prevention of falls and fractures, improving balance and coordination, improving posture, and informing subjects about risk factors for falls and for osteoporosis and fractures. A 3-hour session of information and supervision will be hold for the intervention group by the same physiotherapist who leads the training sessions. The focus is on body awareness and ergonomic advice in specific, daily-life situations (e.g. lifting/carrying, resting positions). | 47 |
| Control Group Control group with no intervention
Subjects in the control group are asked to maintain their current lifestyle. No restrictions are placed on their exercise activities | 42 |
| Total | 89 |
Baseline characteristics
| Characteristic | Control Group | Exercise Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 42 Participants | 47 Participants | 89 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 72 years STANDARD_DEVIATION 5.8 | 70.8 years STANDARD_DEVIATION 5.9 | 71.4 years STANDARD_DEVIATION 5.7 |
| Region of Enrollment Norway | 42 participants | 47 participants | 89 participants |
| Sex: Female, Male Female | 42 Participants | 47 Participants | 89 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 47 | 0 / 42 |
| serious Total, serious adverse events | 0 / 47 | 0 / 42 |
Outcome results
Primary
Time Used to Walk 20 m at Maximal Speed.
Times (measured in seconds) used walking at maximum speed for 20m indoors. No acceleration or deceleration phase used. The type of walking aids used during the test will be recorded. The participants walk as fast as possible wearing their ordinary shoes. The test perform once, the time measured with a stopwatch and the time used on 20 m will be recorded
Time frame: At baseline, 3 and 12 months after the baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Exercise Group | Time Used to Walk 20 m at Maximal Speed. | Baseline | 14.9 Seconds | Standard Deviation 4.3 |
| Exercise Group | Time Used to Walk 20 m at Maximal Speed. | 3 months | 13.4 Seconds | Standard Deviation 4.1 |
| Exercise Group | Time Used to Walk 20 m at Maximal Speed. | 12 months | 13.8 Seconds | Standard Deviation 4.7 |
| Control Group | Time Used to Walk 20 m at Maximal Speed. | 3 months | 15.2 Seconds | Standard Deviation 4.3 |
| Control Group | Time Used to Walk 20 m at Maximal Speed. | 12 months | 15.3 Seconds | Standard Deviation 4.7 |
| Control Group | Time Used to Walk 20 m at Maximal Speed. | Baseline | 14.7 Seconds | Standard Deviation 3.5 |
Secondary
Falls-Efficacy Scale-International
A 16- item self report or interview- based questionnaire assessing the fear of falling during basic and more demanding activities of daily living (Yardley et al. 2005). Each item is scored on a four point scale. Minimun score indicating low concern about falling is 16. The maximun score indication high concern about falling is 64.
Time frame: Baseline, 3 months follow-up, 12 months follow up
Secondary
Functional Reach
The maximum distance in centimetres that can be reached forward in a standing position while maintaining a fixed base of support. Subjects will be instructed to stand sideways against a wall in a natural position and stretch one arm forward level with the shoulder. The position of the third metacarpophalangeal (MCP) joint was taken as the zero point. With the body tilted forward as far as possible, the subjects continued to stretch the arm parallel to the ground. Amount of cm indicate better balance.
Time frame: At baseline, 3 and 12 months after the baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Exercise Group | Functional Reach | Baseline | 26.1 Centimetres | Standard Deviation 6.7 |
| Exercise Group | Functional Reach | 3 months | 27.7 Centimetres | Standard Deviation 6.5 |
| Exercise Group | Functional Reach | 12 months | 27.1 Centimetres | Standard Deviation 6.5 |
| Control Group | Functional Reach | Baseline | 27.4 Centimetres | Standard Deviation 6.3 |
| Control Group | Functional Reach | 3 months | 25.2 Centimetres | Standard Deviation 7.5 |
| Control Group | Functional Reach | 12 months | 27.7 Centimetres | Standard Deviation 5.4 |
Secondary
General Health Questionnaire 20 (GHQ20).
GHQ-20 is a generic instrument and registers distress and psychopathology. GHQ-20 is self-administered and the answers to each item may be treated as a Likert Scale and have weights assigned to each position (0-1-2-3) where 0 is no distress, and 3 is severe distress. This gives a possible range for the total GHQ-20 score of 0-60. Higher scores indicating poor qol.
Time frame: At baseline, 3 and 12 months after baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Exercise Group | General Health Questionnaire 20 (GHQ20). | Baseline | 18.7 units on a scale | Standard Deviation 8.8 |
| Exercise Group | General Health Questionnaire 20 (GHQ20). | 3 months | 15.1 units on a scale | Standard Deviation 7 |
| Exercise Group | General Health Questionnaire 20 (GHQ20). | 12 months | 16.1 units on a scale | Standard Deviation 7.1 |
| Control Group | General Health Questionnaire 20 (GHQ20). | Baseline | 20 units on a scale | Standard Deviation 6.9 |
| Control Group | General Health Questionnaire 20 (GHQ20). | 3 months | 19.8 units on a scale | Standard Deviation 7.4 |
| Control Group | General Health Questionnaire 20 (GHQ20). | 12 months | 19 units on a scale | Standard Deviation 6.1 |
Secondary
QUALEFFO 41
Quality of Life Questionnaire issued by the European Foundation for Osteoporosis (QUALEFFO-41), is a disease-specific questionnaire to be used by patients with vertebral fractures attributed to osteoporosis. QUALEFFO-41 is self-administered and contains questions in five domains: pain, ability to perform physical functions, social functioning, general health perception and mental performance. These five domains can be evaluated individually or be represented in a total score. All scores in all the domains are expressed in values ranging from 0-100, where 0 represents the best and 100 the worst. The total QALEFFO score is calculated as a sum of all answers to items and then linearly transformed on the scale 0-100. High scores indicate poor quality of life.
Time frame: At baseline, 3 and 12 months after the baseline
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Exercise Group | QUALEFFO 41 | Baseline | 31.8 units on a scale | Standard Deviation 14.4 |
| Exercise Group | QUALEFFO 41 | 3 months | 29.8 units on a scale | Standard Deviation 14.3 |
| Exercise Group | QUALEFFO 41 | 12 months | 28.7 units on a scale | Standard Deviation 13.5 |
| Control Group | QUALEFFO 41 | Baseline | 31.3 units on a scale | Standard Deviation 13.3 |
| Control Group | QUALEFFO 41 | 3 months | 31.5 units on a scale | Standard Deviation 14.9 |
| Control Group | QUALEFFO 41 | 12 months | 31.7 units on a scale | Standard Deviation 14.8 |
Secondary
Timed Up & Go Test (TUG)
The subject will be instructed to rise from a chair with a seat height of 43 cm, walk 3 m, turn around, return and sit down again, wearing ordinary footwear and use customary walking aids if necessary.
Time frame: At baseline, 3 and 12 months after the baseline.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Exercise Group | Timed Up & Go Test (TUG) | Baseline | 7.9 Seconds | Standard Deviation 2.6 |
| Exercise Group | Timed Up & Go Test (TUG) | 3 months | 7.5 Seconds | Standard Deviation 2.1 |
| Exercise Group | Timed Up & Go Test (TUG) | 12 months | 7.3 Seconds | Standard Deviation 2.1 |
| Control Group | Timed Up & Go Test (TUG) | Baseline | 8.3 Seconds | Standard Deviation 2.4 |
| Control Group | Timed Up & Go Test (TUG) | 3 months | 8.7 Seconds | Standard Deviation 2.8 |
| Control Group | Timed Up & Go Test (TUG) | 12 months | 8.5 Seconds | Standard Deviation 2.5 |