What was the problem?
Increasing numbers of people live with osteoporosis and vertebral fractures, which cause significant pain due to change in posture and height loss.
This hinders the activities of daily living by making breathing difficult and reducing confidence.
Patients can start a negative cycle of inactivity, ceasing to exercise due to pain and therefore becoming weak and deconditioned.
Group-based exercise programmes have proved successful for other long-term conditions, but fear of movement is an added challenge for these patients.
What was the solution?
Making group-based exercise acceptable for patients with vertebral fractures due to osteoporosis.
The initial group was run using a plan-do-study-act model. After each session there would be discussion about the educational needs, level of intensity and types of exercise in the class.
This enabled the trust to tailor sessions to the group and to identify pathways to refer patients on discharge so they could continue to exercise.
What were the results?
- there is no waiting list to see a specialist physiotherapist if a patient has vertebral fractures due to osteoporosis — the consultant or nurse specialist can book patients directly. Previously, patients had to wait three months
- the group-based exercise has a completion rate of 54%, comparable with pulmonary rehabilitation and heart failure rehabilitation
- sixty-six patients were referred to other centres to continue exercising
- posture improved by an average 1.7cm using the tragus-to-wall test
- grip strength improved by an average of 7kg
- balance showed no significant change in median turn 180, but average steps reduced
- cardiovascular fitness improved by over 50m on average
- eighty-four per cent of patients improved their health-related quality of life with a strong bias towards pain reduction
- patients are still given a choice between one-to-one and group exercise
What were the learning points?
- group-based exercise is an acceptable intervention for patients with osteoporosis and vertebral fractures
- working closely with the specialist consultant, nurses and admin team enabled this innovation to move from an idea into accepted practice
- spending more sessions in group-based exercise enabled the specialist physiotherapist to identify more suitable options for patients and refer them to other exercise groups such as tai chi
- working in clinic has enabled more collaboration between the specialist physiotherapist, specialist nurses and the bone clinic consultant
- group exercise with education seems to be effective across several outcome measures important to patients