Identification and treatment of back pain in elderly women with osteoporosis

Older women with osteoporosis and back pain are common patients in primary health care. Varied physical exercise with focus on back extensor strength and balance is an important non-pharmacological treatment method that these patients can benefit from. Aim The overall aim of this thesis was to gain knowledge about complementary treatment methods of back pain in older women with osteoporosis with or without vertebral fractures in primary health care. Material and Methods Study I, a cross-sectional study, studied the relationship between spinal curvature and balance in a cohort of 96 women, 81-91 years old. Study II was an Randomised Controlled Trial (RCT) with 113 women ≥60 years, randomized to treatment with an activating spinal orthosis, to equipment training and to a control group during a treatment period of six months. Study III was a qualitative study in which 18 women were interviewed in five focus groups about their perceptions and experiences of using the activating spinal orthosis. Study IV was a post-intervention follow up study of the spinal orthosis group (n=38) and the exercise group (n=38) six months after the end of the RCT. We investigated how back pain, back extensor strength and other outcomes were affected when the participants used the spinal orthosis and the home exercise programme voluntarily. Results Study I: It was found that 31% of the women had suffered a vertebral fracture. Women with hyperkyphosis (n=45) had a better ability to tandem standing with eyes open, tandem gait forwards and tandem gait backwards. The age-adjusted Odds ratio (OR) to perform tandem gait (cut-off at four steps) for women with hyperkyphosis were for tandem gait forward OR 2.8 (CI 95% 1.1-7.4) and tandem gait backwards, compared to women without hyperkyphosis. Study II: Analysis between the activating spinal orthosis group, the training group, and the control group showed neither significant difference in back extensor strength nor in back pain, after six months of intervention. Women who had been treated with the activating spinal orthosis had insignificantly increased their back extensor strength with 27% (from 64.4 N to 81.7 N, p = 0.053) after six months of treatment. Women in the equipment training group increased their back extensor strength by 22% (from 59.6 N to 72.8 N, p = 0.013). Perceived back pain measured with VAS and Borg CR-10 showed no significant change in any group at the end of the RCT. Study III: The overall theme was “A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life.” Study IV: Independent use of the activating spinal orthosis and independent training, did not change previously obtained results in back extensor strength or other variables that were examined. Conclusion The results of the thesis indicate that the activating spinal orthosis could be used as an aid and as a training method for individuals with osteoporosis and back pain. However, physical training that involves and improves several functions of the body should be considered as the first-hand choice

Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care

Women with osteoporosis and back pain took part in focus group interviews and described their experiences of using and handling an activating spinal orthosis. The women described the back orthosis as being like a "close friend", a support in everyday life and a reminder to maintain a good posture. Purpose The purpose of this study was to describe and gain a deeper understanding of the views of older women with osteoporosis and back pain seeking primary care regarding their use and handling of an activating spinal orthosis. Method We chose a qualitative method whereby information was gathered via focus group interviews and analysed using inductive content analysis. Women who previously participated in a randomised controlled trial and wore an activating spinal orthosis for 6 months were asked. Out of 31 women, 18 agreed to participate. Five focus group interviews were conducted. Results The analysis resulted in an overall theme in which the experiences of wearing the spinal orthosis were described as follows: "A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life". The overall theme was based on three main categories: impact on daily life, individual adaptation and personal relationship. The main categories were well differentiated from each other but had an interdependency. All three categories involved cases in which the spinal orthosis was perceived as relieving symptoms and making daily life easier, as well as when it was perceived as being hard to manage and provided no symptom relief. Conclusion In older women with osteoporosis and back pain, an activating spinal orthosis could be perceived as being a "close friend" and a support in everyday life. To facilitate acceptance of the spinal orthosis, it was important for it to be well adapted and for follow-ups to be carried out regularly.Funding Agencies|Karolinska InstituteKarolinska Institutet</p

Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain : A Postintervention Follow-Up Study

Objective: To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis. Design: A 6-month postintervention follow-up of women who were involved in the interventions in the RCT.SettingThe study was conducted in a primary health care center in Stockholm, Sweden.ParticipantsIn this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT. Interventions: The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily. Main Outcome Measures: Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10

Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial

The treatment effect of an activating spinal orthosis on back pain and back extensor strength was compared to a training group and to a control group. Between the groups, there was no significant difference in back pain, back extensor strength, or kyphosis index after the 6months of treatment.PurposeThe aim of this study was to study the effect of treatment with an activating spinal orthosis on back pain, back extensor strength, and kyphotic index. Our hypothesis was that an activating spinal orthosis may be an alternative treatment to decrease back pain and increase back extensor strength.MethodsA total of 113 women aged 60years with back pain and osteoporosis, with or without vertebral fractures, were randomized to three groups: a spinal orthosis group, an equipment training group, and a control group. All three groups were examined at baseline and followed up after 3 and 6months. Statistical analyses were performed with a mixed model for repeated measures according to intention to treat (ITT) and per protocol (PP).ResultsA total of 96 women completed the study. Between the groups, there was no significant difference in baseline characteristics. Comparison between groups showed no significant difference in back pain, back extensor strength, or kyphosis index at the follow-up after 6months according to ITT and PP analyses. Analysis in each group showed that the back extensor strength had increased by 26.9% in the spinal orthosis group, by 22.1% in the exercise training group and by 9.9% in the control group.ConclusionsSix months treatment by an activating spinal orthosis showed no significant difference in back pain, back extensor strength, or kyphosis index between the three groups. In the spinal orthosis group, present back pain decreased slightly and back extensor strength increased by 26.9% which indicates that the spinal orthosis may become an alternative training method.Clinicaltrials.com ID: NCT03263585Funding Agencies|Stockholm County Council</p