Abstract
Summary of: Barker KL, Newman M, Knight R, Hannink E, Hughes T, Barreto C, et al. Exercise rehabilitation with tailored support for exercise adherence for people with vertebral fragility fractures is more effective than standard rehabilitation: the OPTIN randomised controlled trial. Osteoporos Int. 2025;36:1621–1631.
Question: Does an exercise-based rehabilitation program with integrated adherence support improve functional mobility in patients with vertebral fragility fractures compared with exercise alone? Design: Randomised controlled trial with concealed allocation, blinded outcome assessment and intention-to-treat analysis. Setting: Physiotherapy and osteoporosis clinics in the UK. Participants: Key inclusion criteria were age ≥ 55 years, at least 1 year post-menopausal (if female), diagnosis of one or more vertebral fragility fractures, experienced back pain in the past 12 months and medically stable (eg, stable cardiovascular condition, no other condition resulting in bone loss). Exclusion criteria were primary back pain radiating into the lower limb or having received vertebroplasty, spinal injection or physiotherapy in the past 12 weeks. A total of 126 participants were randomised: 63 to an exercise with integrated adherence support and 63 to exercise alone. Interventions: All participants received a 4-month, evidence-based outpatient exercise program tailored to their individual needs, delivered either in person or virtually. The intervention group concurrently received tailored behavioural support and materials to help set goals and overcome barriers to exercise adherence, with flexible input from physiotherapists over the 4 months. Outcome measures: The primary outcome was change in functional mobility (assessed via the Timed Up and Go test [TUG], in seconds) from baseline to 12 months. Secondary outcomes included walking capacity (6-minute walk test), grip strength, pain, thoracic kyphosis, timed loaded shoulder and back muscle endurance, quality of life, number of falls, adverse events and costs for a health–economic analysis. Results: A total of 112 participants (89%) completed the 12-month follow-up. The intervention led to superior improvements in TUG time (MD 2.1 seconds, 95% CI –3.1 to –1.0), walking capacity (MD 24.5 m, 95% CI 5.7 to 43.4) and quality of life (MD 4.6, 95% CI 0.02 to 9.1) but not other outcomes. Adverse events and falls were similar in both groups. However, medically attended falls were fewer in the intervention group. The intervention was cost-effective. Conclusion: Integrating tailored adherence support into an exercise program produced clinically meaningful improvements in functional mobility and walking capacity, reduced medically attended falls and was cost-effective compared with usual care.
Provenance: Invited. Not peer reviewed.