Effect of Early Rehabilitation Treatment on Activities of Daily Living in Patients Receiving Conservative Treatment for Vertebral Compression Fracture

Physical Therapy for Patients with Thoracolumbar Vertebral Fractures

Vertebral fractures are a common cause of back pain and pain-related functional impairments in elderly patients. Despite their widespread occurrence, vertebral fractures frequently remain underdiagnosed, often leading to suboptimal management and poor clinical outcomes. This review specifically examines the role of physical therapy (PT) in managing vertebral fractures, describing current literature and evidence-based guidelines from the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons. PT following vertebral fractures has been shown to significantly improve back pain and patient-reported outcomes, with studies even showing a correlation between resistance and aerobic training with improved bone mineral density. These findings highlight the need for interdisciplinary care and comprehensive PT interventions to address the growing burden of vertebral fractures as their incidence rises with the aging population.

Prediction of Walking Independence in Older Women with Vertebral Compression Fracture Using Phase Angle: A Preliminary Study Using Propensity Score

Objectives

This study aimed to clarify whether phase angle can be a predictor of walking independence in older women with vertebral compression fractures (VCFs) and to determine a clinically usable cutoff value.

Methods

We retrospectively assessed data of older women (n=59; median age, 83.0 years) with VCFs. Propensity score-matching and logistic regression were performed to examine the association between phase angle at admission and walking independence at discharge. The cutoff value for the phase angle at admission for predicting walking independence was calculated based on the receiver operating characteristic curve.

Results

Thirty-one patients (52.5%) could walk independently at discharge. Thirty patients were extracted from the independent and non-independent groups according to the propensity score. After propensity score matching, there was no significant difference between the groups for age, medical history, knee extension strength, skeletal muscle mass index, mini nutritional assessment-short form score, or revised Hasegawa's dementia scale score. However, the phase angle of the independent group was significantly higher than that of the non-independent group (P<0.05). Logistic regression revealed that phase angle at admission was significantly associated with walking independence at discharge (odds ratio, 12.2; 95% confidence interval, 2.1-72.0; P<0.01). The area under the receiver operating characteristic curve was 0.868, and the calculated phase angle cutoff value was 3.55°.

Conclusions

This study revealed that the phase angle can predict walking independence in older women with VCFs. The cutoff values for women calculated in this study can be used as a simple and objective predictive index of walking independence.

Impact of body mass index on outcomes of inpatients with vertebral compression fractures in Japan: A retrospective cohort study

AIM

The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures.

METHODS

A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2 ), normal weight (18.5-22.9 kg/m2 ), overweight (23.0-27.4 kg/m2 ) and obese (≥27.5 kg/m2 ) according to the World Health Organization criteria for the Asia-Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge.

RESULTS

Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30-day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain -3.63 points (95% confidence interval -4.58 to -2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001).

CONCLUSIONS

In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788-794.

Cumulated ambulation score in hospitalized patients with osteoporotic vertebral fractures is an important predictor of returning home: a retrospective cohort study

Osteoporotic vertebral fractures are recognized as a serious problem in the aging society. In this study, we found that the cumulated ambulation score predicts returning home in patients with osteoporotic vertebral fractures. The cumulated ambulation score is an important piece of information in determining the destination of patients with osteoporotic vertebral fractures.

PURPOSE

Osteoporotic vertebral fractures are a serious problem affecting the health status of the elderly, and if they require inpatient treatment, they may have difficulty deciding where to discharge. The study's purpose is to investigate whether the cumulated ambulation scores predict returning home for hospitalized osteoporotic vertebral fractures patients.

METHODS

The subjects were 120 osteoporotic vertebral fractures patients aged 65 years or older who were admitted to our hospital between April 2015 and March 2022. The cumulated ambulation scores for all subjects were measured in the 3-days right after admission. A multivariable analysis was performed with the dependent variable as whether the patient returned home and the independent variable as the cumulated ambulation score. Three models were created from the measured cumulated ambulation score, and each model was analyzed as an independent variable (model 1; score on the 1st day, model 2; total score on the 2-days, model 3; total score on the 3-days).

RESULTS

The length of hospitalization for the osteoporotic vertebral fracture's patients were 11.8 ± 5.3 days, and 80 (66.7%) returned home. Multivariable analysis showed that cumulated ambulation score was a predictor of returning home (model 1, odds ratio: 3.151, 95% confidence interval: 2.074-5.203; model 2, odds ratio: 2.234, 95% confidence interval: 1.685-3.187; model 3, odds ratio: 1.929, 95% confidence interval: 1.535-2.599).

CONCLUSION

The cumulated ambulation score of patients with osteoporotic vertebral fractures right after admission is a factor that affected returning home and is useful in determining where patients are discharged.