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Nakagawa M1, Kawakami M1, Teraguchi M1, Kagotani R1, Minetama M1, Kitano K1, Koike Y1, Yamamoto Y1, Sakon N1, Mori N1, Matsuo S1, Nakatani T1, Sumiya T1
1Wakayama Medical University Kihoku Hospital, Spine Care Center, Wakayama, Japan
Background: There are many strategies for treating osteoporotic vertebral fracture (OVF), but which treatments are efficacious and safe remain unknown. In our institute, patients admitted with acute OVF are immobilized using soft thoracolumbar support and a rehabilitation program including exercise is applied as so-called “stay active” therapy to maintain patients' activities at the level before fracture.
Purpose: To investigate the short-term outcomes of stay active therapy for patients with acute OVF, and to examine which factors affected residual pain in acute OVF treated with our strategy.
Methods: In the present retrospective cohort study, we included 126 patients with acute OVF who underwent stay active therapy in our institute between January 2010 and May 2017. We recorded their demographic data including age, gender, body mass index (BMI), duration to hospitalization from injury, and length of hospital stay. A visual analogue scale (VAS) for back pain and functional independence measure (FIM) were calculated at admission, at 2 weeks, and at discharge. As radiological assessments, the regions of acute OVF, the number of existing fractures, collapse ratio of the fractured vertebral body, and kyphotic angle at the affected level, were evaluated. Patients were divided into two groups according to the minimal clinically important difference (MCID) of the VAS at 14 days after treatment: group I (MCID >20 mm) and group II (MCID 20 mm). All patients were followed up at 4 weeks after admission. We statistically compared the two groups to clarify whether our strategy resulted in pain relief and improvement of FIM. In addition, multiple regression analysis was used to identify the risk factors for group II.
Results: In group I, there were 102 patients and in group II, 24 patients. Age, gender, BMI, duration to hospitalization from injury, length of hospital stay, the number of existing fractures, regions of acute OVF, local kyphotic angle, and FIM did not differ between the two groups. The VAS in group I was significantly improved (mean 74 mm at baseline, 29 mm at 14 days, 22 mm at follow-up, P 0.001). By contrast, in group II, the VAS at the baseline was not improved at 14 days (mean 64 mm, 65 mm, P > 0.05) and the VAS was only slightly improved at follow-up (47 mm, P 0.05). Collapse ratio of the fractured vertebral body was less in group II than in group I at each measurement (mean 1.2 and 0.7 mm at baseline, 1.2 and 0.7 mm at follow-up, P 0.05). The VAS at follow-up was related only to the initial VAS (OR: 0.94, 95% CI 0.0001-0.394, P 0.05).
Conclusion(s): Short-term outcome of acute OVF treated with our conservative therapy was affected by only the initial VAS. The factors including age, gender, BMI, the number of existing fractures, regions of acute OVF, collapse ratio or kyphotic angle were not related to poor short-term outcome, thus stay active therapy should be considered.
Implications: Patients with OVF are able to improve their back pain and maintain the ambulation ability by undertaking stay active therapy.
Keywords: Osteoporotic vertebral fracture, early mobilization, residual pain
Funding acknowledgements: No funding was received for this project.
Purpose: To investigate the short-term outcomes of stay active therapy for patients with acute OVF, and to examine which factors affected residual pain in acute OVF treated with our strategy.
Methods: In the present retrospective cohort study, we included 126 patients with acute OVF who underwent stay active therapy in our institute between January 2010 and May 2017. We recorded their demographic data including age, gender, body mass index (BMI), duration to hospitalization from injury, and length of hospital stay. A visual analogue scale (VAS) for back pain and functional independence measure (FIM) were calculated at admission, at 2 weeks, and at discharge. As radiological assessments, the regions of acute OVF, the number of existing fractures, collapse ratio of the fractured vertebral body, and kyphotic angle at the affected level, were evaluated. Patients were divided into two groups according to the minimal clinically important difference (MCID) of the VAS at 14 days after treatment: group I (MCID >20 mm) and group II (MCID 20 mm). All patients were followed up at 4 weeks after admission. We statistically compared the two groups to clarify whether our strategy resulted in pain relief and improvement of FIM. In addition, multiple regression analysis was used to identify the risk factors for group II.
Results: In group I, there were 102 patients and in group II, 24 patients. Age, gender, BMI, duration to hospitalization from injury, length of hospital stay, the number of existing fractures, regions of acute OVF, local kyphotic angle, and FIM did not differ between the two groups. The VAS in group I was significantly improved (mean 74 mm at baseline, 29 mm at 14 days, 22 mm at follow-up, P 0.001). By contrast, in group II, the VAS at the baseline was not improved at 14 days (mean 64 mm, 65 mm, P > 0.05) and the VAS was only slightly improved at follow-up (47 mm, P 0.05). Collapse ratio of the fractured vertebral body was less in group II than in group I at each measurement (mean 1.2 and 0.7 mm at baseline, 1.2 and 0.7 mm at follow-up, P 0.05). The VAS at follow-up was related only to the initial VAS (OR: 0.94, 95% CI 0.0001-0.394, P 0.05).
Conclusion(s): Short-term outcome of acute OVF treated with our conservative therapy was affected by only the initial VAS. The factors including age, gender, BMI, the number of existing fractures, regions of acute OVF, collapse ratio or kyphotic angle were not related to poor short-term outcome, thus stay active therapy should be considered.
Implications: Patients with OVF are able to improve their back pain and maintain the ambulation ability by undertaking stay active therapy.
Keywords: Osteoporotic vertebral fracture, early mobilization, residual pain
Funding acknowledgements: No funding was received for this project.
Topic: Orthopaedics; Critical care; Disability & rehabilitation
Ethics approval required: Yes
Institution: Wakayama Medical University
Ethics committee: Institutional Review Board of Wakayama Medical University
Ethics number: 2391
All authors, affiliations and abstracts have been published as submitted.
