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Secondary prevention after distal radius fracture: a prospective observational study of the effect of an exercise intervention
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Physiotherapy.
(English)Manuscript (Other academic)
Abstract [en]

This prospective observational study evaluated the effect of a four-week educational and exercise program, entitled the osteoporosis school. Two hundred and thirteen women with a distal radius fracture (mean age 66 years) were invited and 41 of them (mean age 64 years) accepted to join an exercise group (exercisers), 172 (mean age 66 years) declined and became a control group (non-exercisers). The intervention was followed by a one-year self-administrated exercise program. Bone mineral density (BMD), functional tests of dynamic and static balance, and leg strength were evaluated before and after the one-year intervention period and falls were registered in a fall diary. No statistically significant mean difference was found in dynamic or static balance between the exercisers and the non-exercisers. However, both groups showed improved balance (walking backwards and standing on one leg with eyes open over the study time (p<0.01). After the intervention, no significant difference was found between the groups in the one-leg rise test (p=0.494). The mean T-score was -1.859 at the baseline and -1.951 after intervention for the exercisers, and -2.0 and -2.064 for the non-exercises. There was no statistically significant difference in prospective falls between the exercisers and the non-exercisers (p= 0.272). Twelve of 41 exercisers (29.3%) and 37 of 172 non-exercisers (21.5%) reported one or more falls. Conclusion: Only 19% of the patients with a recent radius fracture accepted to participate in the osteoporosis school. The osteoporosis school with a 12-month home-based exercise program had no established effect on BMD, balance, leg strength or falls. This lack of proven efficacy for the secondary prevention of distal radius fractures, highlights the need for further research on better and more controlled interventions and for long-term randomised controlled follow-up studies.

Keyword [en]
Intervention, osteoporosis school, bone mineral density (BMD), distal radius fracture, dynamic balance, static balance, one-leg rise-test, fall diary
Identifiers
URN: urn:nbn:se:umu:diva-22092OAI: oai:DiVA.org:umu-22092DiVA: diva2:212654
Available from: 2009-04-23 Created: 2009-04-23 Last updated: 2010-01-14Bibliographically approved
In thesis
1. Factors in secondary prevention subsequent to distal radius fracture: Focus on physical function, co-morbidity, bone mineral density and health-related quality of life
Open this publication in new window or tab >>Factors in secondary prevention subsequent to distal radius fracture: Focus on physical function, co-morbidity, bone mineral density and health-related quality of life
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary.

The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis.

Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up.

Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls.

The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.

Place, publisher, year, edition, pages
Umeå: Institutionen för samhällsmedicin och rehabilitering, 2009. 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1252
Keyword
distal radius fracture, bone mineral density (BMD), functional tests, mortality, morbidity, the SF-36, fall diary
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-22102 (URN)978-91-7264-742-8 (ISBN)
Distributor:
Sjukgymnastik, 901 87, Umeå
Public defence
2009-05-20, B 101, Vårdvetarhuset, Byggnad 15, 901 87 Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2009-04-29 Created: 2009-04-23 Last updated: 2010-01-18Bibliographically approved

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