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Recommendations suggest a multicomponent exercise for people with osteoporosis. We identified rehabilitation professionals' barriers and facilitators to implementing exercise recommendations with people with osteoporosis, and used those to make suggestions for targeted knowledge translation interventions. Future work will report on development and evaluation of the interventions informed by our study., Purpose: Rehabilitation professionals can help people with osteoporosis to engage in a multicomponent exercise program and perform activities of daily living safely. However, rehabilitation professional face barriers to implementing exercise evidence, especially for specific disease conditions like osteoporosis. We performed a behavioural analysis and identified rehabilitation professionals' barriers to and facilitators of implementing disease-specific physical activity and exercise recommendations (Too Fit to Fracture recommendations), and used the Behaviour Change Wheel to select interventions., Methods: Semi-structured interviews and focus groups were conducted with rehabilitation professionals, including physical therapists, kinesiologists, and occupational therapists, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and relevant interventions were identified., Results: Ninety-four rehabilitation professionals (mean age 40.5 years, 88.3% female) participated. Identified barriers were as follows: capability-lack of training in behaviour change, how to modify recommendations for physical and cognitive impairments; opportunity-lack of resources, time, and team work; motivation-lack of trust between providers, fear in providing interventions that may cause harm. Interventions selected were as follows: education, training, enablement, modelling and persuasion. Policy categories are communication/marketing, guidelines, service provision and environmental/social planning., Conclusions: Key barriers to implementing the recommendations are rehabilitation professionals' ability to use behaviour change techniques, to modify the recommendations for physical and cognitive limitations and to feel comfortable with delivering challenging but safe interventions for people with osteoporosis, and lacking trust and team work across sectors. Future work will report on development and evaluation of knowledge translation interventions informed by our study.

Background: Exercise such as yoga may have health benefits for older adults with osteoporosis, but without attention to safe movement yoga can also increase the risk for injury., Objective: The current article provides suggestions for how to adapt yoga to the needs of older adults with osteoporosis., Suggestions: A general guidelines for exercise is that older adults with osteoporosis should participate in a multicomponent exercise program, including resistance and balance training. Contraindicated movements include end-range flexion/extension/rotation of the spine and internal/external rotation of the hip. Yoga postures that should be encouraged include postures emphasizing spinal alignment and extension to mid-range in standing and on the floor. Overarching considerations for participation in yoga are that classes should be designed for higher-risk older adults, led by an instructor who has had proper training with individuals with osteoporosis, should be a noncompetitive environment, and should give attention to which postures are safe and how to transition safely.

To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs) We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation. Non-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms. To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care. [ABSTRACT FROM AUTHOR]

Objective This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. Methods VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. Results VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. Conclusion VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. Impact The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. Design and setting: We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. Participants: Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). Results: Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. Conclusion: Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers. [ABSTRACT FROM AUTHOR]

Provision of spinal manual therapy for people with osteoporosis is controversial: the effect and safety have not been studied in-depth and are unclear. To provide an overview about spinal manual therapy and its safety and applicability for people with osteoporosis. We conducted two separate search strategies of biomechanical and clinical literature in PubMed, EMBASE, and Sportdiscus (1955–2020) to answer the following research questions: (1) How much force results from spinal mobilizations and is required to fracture vertebral components with spinal mobilizations? (2) What spinal manual therapy techniques have been described and what are their effects for people with osteoporosis? (3) What adverse events have been reported? 16 articles described forces produced by PA mobilization varying widely by grade of mobilization [(9 to 205.8 N (Grade I), 2.2 to 119.23 N (Grade II), 75.5 to 206 N (Grade III), and 89.2 to 499.8 N (Grade IV)]. One article identified vertebral components fail under PA loads of 200 to 727 N. One case study and three randomized controlled trials were included. Mobilization techniques used were Grade II to IV with no serious adverse events reported. Our narrative review revealed limited literature about the risk and clinical benefits of spinal manual therapy for people with osteoporosis. Further, the forces applied during spinal manual therapy techniques vary widely between therapists depending on the area being treated and patient characteristics. Further work about spinal manual therapy for people with osteoporosis is necessary to draw conclusions about safety and effectiveness. [ABSTRACT FROM AUTHOR]

Background Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. Objective This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. Design This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. Setting This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. Participants This study included 141 women ≥65 years of age with radiographically confirmed vertebral fractures. Intervention A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise ≥3 times weekly. Controls received equal attention. Measurements Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. Results There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = −1.58 [95% CI = −3.09 to −0.07], intention-to-treat; MD = −1.49 [95% CI = −3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. Limitations Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. Conclusions Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials. [ABSTRACT FROM AUTHOR]