Non-Pharmacological Management of Osteoporotic Vertebral Fractures: A Qualitative Analysis of Health-Care Professional Perspectives And Experiences.

Introduction: Vertebral fractures are the most prevalent fractures among individuals living with osteoporosis, affecting at least 20% of the older population. Our objective was to understand health care professionals' (HCPs) experiences and perceptions of post-vertebral fracture rehabilitation, use of non-pharmacological strategies, and virtual rehabilitation. Methods: We performed a thematic and content analysis of semi-structured interviews that were conducted over web conference/telephone with HCPs within Canada. Criterion, purposeful, and snowball sampling was used to recruit HCPs that have experience treating patients with osteoporotic vertebral fractures. Questions for the interview guide were centred on current practices, non-pharmacological treatments, and virtual rehabilitation. Results: 13 HCPs (7F, 6M, aged 46 ± 12 years) were interviewed. Two major themes emerged from our interviews: (1) rehabilitation of vertebral fractures is dependent on the acuity of fracture, and (2) care gaps in referral and access to rehabilitation. Early rehabilitation interventions included pain and osteoporosis medicine, education on harmful and high-risk movements, and non-pharmacological strategies to help reduce patient pain and increase early mobilization. Rehabilitation in the chronic stage of vertebral fractures incorporated more exercise-based strategies to help increase strength, mobility and functionality and was informed by a comprehensive assessment. Regardless of the stage of recovery, barriers such as delayed identification of fracture, delayed or no referral to physiotherapy, and lack of knowledge of osteoporosis or vertebral fracture among HCPs may reduce the access to or effectiveness of non-pharmacological interventions. HCPs believed that virtual rehabilitation that includes an online educational component, an online assessment, and online exercise classes in groups tailored to individuals could be a feasible alternative. Conclusion: We have identified that rehabilitation provided by HCPs was dependent on the acuity or stability of fracture, and that non-pharmacological interventions were facilitated by physiotherapy. To select and individualize physical therapy interventions, physiotherapists emphasized using assessments to determine patient goals, physical functioning, and identify comorbidities. To improve access and address barriers, virtual rehabilitation could be a feasible and effective alternative for patients but may require further evaluation. [ABSTRACT FROM AUTHOR]