Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

MacDermid, Joy C.

Abstract

Background:

Osteoporosis is a bone disease that increases the risk of fractures. In adults aged 50-65 years, a wrist fracture is usually the first sign of osteoporosis. Fracture risk increases if these individuals are not taught to exercise, eat properly, and/or identify fall risk factors early in their diagnosis.

Methods:

A meta-analysis was conducted to determine whether a home fall hazard identification program could reduce the risk of falls in community dwelling adults and an overview of exercise in individuals with a distal radius fracture (DRF). CINHAL, PubMed, EMBASE, Scopus, and Psych INFO were used to identify articles. A survey was distributed to individuals with osteoporosis to ask them their exercise preferences. In-depth interviews were conducted to better understand the type of health professionals providing osteoporosis management advice. Interviews were transcribed verbatim and coded sentence-by-sentence. A randomized control trial was developed as a feasibility study. Participants engaged in the home program online, twice a week for six weeks. Trial registration: NCT03997682

Results:

In the falls meta-analysis, a total of 8 studies (n=8) and 5,177 participants were included. Pooled effects from 5 studies indicated no difference between fall hazards identification programs and control. Exercise improves health outcomes following DRF, but study quality was poor. Survey data from 287 individuals was collected. The sample was 90% female with a mean age of 67 (SD: 10.7) years. Home (n=171, 62%) was the preferred location to exercise. Improving strength (n=241, 84%) was the most important goal and reducing falls (n=129, 45%) was the least important. In the interviews, it was found that people with osteoporosis rely on physicians, other healthcare professionals, and non-healthcare professionals for advice. In the RCT, 63 participants were recruited over 12 months. The threshold for demonstrating retention was met (75% of participants attending their 6-month visit). Adherence was not met, at 56%.

Discussion:

We used patient input and the literature to ensure the intervention for the RCT is evidence based. Preliminary results indicate that the RCT is feasible, by approaching our recruitment numbers and retention goals, should we decide to move forward with a full RCT.

Summary for Lay Audience

This thesis looked at strategies, that do not involve medication, to reduce the risk of falling and fracturing for people with osteoporosis. There are five studies that are presented to better understand how to manage osteoporosis without medication, by using interventions that reduce the risk of falling, increasing exercise and improving nutrition. The first study was a summary of the literature looking at aspects inside an individual’s home that could put them at risk of falling. This study found that although identifying these hazards did not reduce the risk of falling, it did help individuals better understand these hazards. The second study was looking at exercise for people after a broken wrist, again summarizing studies that were already published. This study found that the exercise seems to help with recovery after a broken wrist, but the studies were not very well conducted so it is unclear how much we can trust these results. The third study used a survey to ask people with osteoporosis about their exercise preferences. Most people preferred to exercise at home, to try to improve strength. The fourth study was to interview people with osteoporosis about how they get information about osteoporosis. It became clear that people with osteoporosis rely on their physician, other healthcare providers, and non-healthcare providers for advice. The last study randomly assigned individuals to an intervention or control group. The intervention group was an exercise and education program twice weekly, for 6 weeks. The control group continued with their usual care. Thresholds were set before the study began to classify if it the study was reasonable to carry out on a larger scale. We wanted to enroll 74 individuals in one year but enrolled 63. We wanted at least 75% of the individuals to complete the final study visit, which we did accomplish. We also wanted the individuals in the intervention group to complete 60% of the program, but only 56% of the intervention was followed. This body of work will inform future studies to see if we can improve the health of individuals with osteoporosis after a broken wrist and to reduce the risk of future fractures.

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