SYNTHESIS OF EVIDENCE-BASED DOCUMENTS ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED OR CONFIRMED OSTEOPOROSIS

K. Avin¹, K. Brewer², K. Camp³, M. Wingood⁴, G. Hartley⁵

¹Indiana University-Indianapolis, Physical Therapy, Indianapolis, United States, ²Mayo Clinic, Physical Therapy, Arizona, United States, ³University of North Texas Health Science Center, Physical Therapy, Fort Worth, United States, ⁴Veterans Affairs, Geriatric Research Education and Clinical Center, Boston, United States, ⁵University of Miami, Physical Therapy, Miami, United States

Background: Evidence-based documents (EBD) are intended to be critical resources for clinicians to support best practice, optimize outcomes and reduce variation. To support the clinical management of patients/clients vulnerable to osteoporosis, three EBDs were recently published. The initial clinical practice guideline (CPG) utilized the ADPAPTE process with the Scottish International Guideline Group CPG. The ADAPTE CPG informed US-based exercise recommendations (Hartley et al. 2020), while gaps in knowledge were addressed through a scoping review of screening tools (Wingood et al, in review), and a Delphi study discussed the essential tests and measures, treatment goals, and interventions for patients with osteoporosis (Avin et al., 2022). These recommendations are to be considered within the context of the comprehensive clinical decision-making process for individual patient, considering their age, gender, and clinical presentation.

Purpose: We intend to narrow the gap between evidence and practice by synthesizing knowledge and developing clinical resources, two commonly reported barriers of evidence-based practice.

Methods: Avin et al., 2022 consisted of a panel of 31 physical therapists with expertise in the care of patients with osteoporosis who were recruited to participate in a modified Delphi process to reach expert consensus on the essential components of physical therapists’ examination and plan of care for patients with osteoporosis.Hartley et al., 2022utilized one of six potential CPGs to support the ADAPTE, such as Too Fit to Fracture (Canada), the National Osteoporosis Guideline Group (UK), but chose to adapt SIGN as it was the most comprehensive. Wingood et al, (in review) used the PRISMA-ScR guidelines to map the available evidence for screening tools for osteoporosis that can be utilized by healthcare providers who do not order imaging. Recommendations were synthesized across the three EBDs to direct the plan of care to facilitate progress of patients with suspected or confirmed osteoporosis. Recommendations spanned the five processes of examination, evaluation, diagnosis, prognosis, and implementation of the POC.

Results: We synthesized recommendations and developed resources for history, tests and measures, education/goals, and treatment using the Delphi study, while the CPG provided exercise-specific guidance.

Conclusions: We developed a comprehensive EBD that provides POC guidance for individuals susceptible to bone mineral loss due to osteoporosis. The EBD was constructed via a systematic and thorough synthesis of peer-reviewed literature and the findings obtained from a structured Delphi analysis, which utilized a panel of expert physical therapists with extensive knowledge in the care of persons with osteoporosis to develop a consensus in patient care in areas not well-identified in the current literature (i.e., assessments treatment goals, and interventions for managing osteoporosis-related impairments, functional limitations, and activity restrictions). Use of EBDs are essential for facilitating the translation of knowledge to clinical practice. Although the ADAPTED CPG was fit for US practice, the recommendations synthesized across the three documents are applicable regardless of geographical location.

Implications: Knowledge translation documents provide a palatable and efficient distillation of current, up-to-date recommendations from EBDs. These knowledge translation documents support practicing clinicians in their clinical decision-making process for patients who are vulnerable towards developing osteoporosis.

Funding acknowledgements: The Academy of Geriatric Physical Therapy, The American Physical Therapy Association.

Keywords:
Osteoporosis
Clinical practice guideline
Bone health

Topics:
Musculoskeletal
Orthopaedics
Older people

Did this work require ethics approval? No

Reason: This is a synthesis of multiple published evidence-based documents that did not require acquisition of new data or subject recruitment/data collection.