Authors: (including presenting author): :
Lam JCT (1), Wong AKH (2), Chao CYL (1), Kwok DKH (1), Chan CTM (1), Lee JWY (1), Yeung MTH (1), Chan SWI (1), Chu AL (1), Leung CYY (1)
Affiliation: :
(1) Physiotherapy Department, Princess Margaret Hospital, (2) Department of Orthopaedic and Traumatology, Princess Margaret Hospital
Keyword 1: :
Osteoporosis
Keyword 2: :
vertebral fracture
Keyword 3: :
clinical pathway
Keyword 4: :
physiotherapy
Introduction: :
Osteoporotic vertebral fractures (OVFs) are the most common single osteoporotic fragility fracture associated with significant morbidity, pain, functional disability, increased falls risk and reduced health-related quality of life. Hospitalized OVF patients tend to be older, frailer and have multiple comorbidities. A standardized clinical care pathway for hospitalized OVF patients has been established and implemented at the Princess Margaret Hospital (PMH) since Aug 2024 that includes routinely referring OVF patients to physiotherapy for in-hospital training during hospitalized period and out-patient training for structured, multicomponent exercise program plus low-magnitude high-frequency vibration (LMHFV) therapy after hospital discharge.
Objectives: :
To evaluate the effects of ward and gym-based physiotherapy exercise training program emphasizing on pain modulation and mobility training on discharge outcomes in hospitalized older people with OVFs.
Methodology: :
This was a prospective study design. Patients aged ≥ 65 years old, abbreviated mental test ≥6, and presented with back pain with spine tenderness that resulting from low energy trauma and with x-ray showed new/recent collapse vertebrae that admitted to the Orthopaedic Wards of PMH were recruited under the OVF pathway. All of them were referred for in-hospital physiotherapy training at the day of hospital admission. The physiotherapy training program included daily ward-based training in weekdays on pain management, early mobilizing them from getting out of bed, standing and walking as tolerated, balance training, education and walking aids prescription. Provision of gym sessions to boost up training were given whenever patients tolerated. Outcomes measures on Numerical Pain Rating Scale (NPRS), Elderly Mobility Scale (EMS), and Modified Functional Ambulatory Category (MFAC) were measured at admission and discharge status, and length of hospital stay (LOS) and discharge destination were also recorded.
Result & Outcome: :
One hundred and twenty-four OVF patients (22 males, 102 females), with a mean age of 75.8±9.0 years were recruited from August 2024 to November 2025. Majority of them were suffered OVFs at spinal level T10 to L4 (94.4%). Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), and hot pack were the most commonly used non-pharmacological physiotherapeutic modalities for pain modulation. At discharge status, the NPRS score reduced from 5.2±2.4 from baseline to 3.4±1.9 (p< 0.001) and EMS score improved from 6.2±5.1 to 8.8±4.1 (p< 0.001). The median MFAC improved from 4 (assisted walker) to 5 (supervised walker) (p< 0.001). The averaged LOS was 6.7±6.7 days. Majority of the patients discharged home directly (106, 85.6%), followed by 11 (8.8%) transferred to rehabilitation hospital, 5 (4%) to residential home and others 2 (1.6%). Among direct home discharge cases, 75 (70.8%) agreed to continue physiotherapy out-patient training after hospital discharge. Standardized pathway for acute OVFs emphasizing pain control and early mobilization during hospitalization significantly improve discharge outcomes and increasing independence and direct home discharge. Further studies are warrant to evaluate the long-term effects of multicomponent exercise program that incorporated the LMHFFV on bone health, fall and secondary fracture prevention.
