Identification and treatment of back pain in elderly women with osteoporosis

Older women with osteoporosis and back pain are common patients in primary health care. Varied physical exercise with focus on back extensor strength and balance is an important non-pharmacological treatment method that these patients can benefit from.

Aim: The overall aim of this thesis was to gain knowledge about complementary treatment methods of back pain in older women with osteoporosis with or without vertebral fractures in primary health care.

Material and Methods: Study I, a cross-sectional study, studied the relationship between spinal curvature and balance in a cohort of 96 women, 81-91 years old. Study II was an Randomised Controlled Trial (RCT) with 113 women ≥60 years, randomized to treatment with an activating spinal orthosis, to equipment training and to a control group during a treatment period of six months. Study III was a qualitative study in which 18 women were interviewed in five focus groups about their perceptions and experiences of using the activating spinal orthosis. Study IV was a post-intervention follow up study of the spinal orthosis group (n=38) and the exercise group (n=38) six months after the end of the RCT. We investigated how back pain, back extensor strength and other outcomes were affected when the participants used the spinal orthosis and the home exercise programme voluntarily.

Results: Study I. It was found that 31% of the women had suffered a vertebral fracture. Women with hyperkyphosis (n=45) had a better ability to tandem standing with eyes open, tandem gait forwards and tandem gait backwards. The age-adjusted Odds ratio (OR) to perform tandem gait (cut-off at four steps) for women with hyperkyphosis were for tandem gait forward OR 2.8 (CI 95% 1.1-7.4) and tandem gait backwards, compared to women without hyperkyphosis. Study II. Analysis between the activating spinal orthosis group, the training group, and the control group showed neither significant difference in back extensor strength nor in back pain, after six months of intervention. Women who had been treated with the activating spinal orthosis had insignificantly increased their back extensor strength with 27% (from 64.4 N to 81.7 N, p = 0.053) after six months of treatment. Women in the equipment training group increased their back extensor strength by 22% (from 59.6 N to 72.8 N, p = 0.013). Perceived back pain measured with VAS and Borg CR-10 showed no significant change in any group at the end of the RCT. Study III. The overall theme was “A well-adapted spinal orthosis could develop into a long-lasting friendship that provided support and help in daily life.” Study IV. Independent use of the activating spinal orthosis and independent training, did not change previously obtained results in back extensor strength or other variables that were examined.

Conclusion: The results of the thesis indicate that the activating spinal orthosis could be used as an aid and as a training method for individuals with osteoporosis and back pain. However, physical training that involves and improves several functions of the body should be considered as the first-hand choice.

List of scientific papers

I. Kaijser Alin C, Grahn Kronhed A-C, Salminen H. The association between spinal curvature and balance in elderly women at high risk of osteoporotic fractures in primary health care. European Journal of Physiotherapy. 2016;18:226-32.
https://doi.org/10.1080/21679169.2016.1185151

II. Kaijser Alin C, Grahn Kronhed A-C, Uzunel E, Alinaghizadeh H, Salminen H. Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial. Archives of Osteoporosis. 2019;14:5.
https://doi.org/10.1007/s11657-018-0555-0

III. Kaijser Alin C, Frisendahl N, Grahn Kronhed A-C, Salminen H. Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care. Archives of Osteoporosis. 2020;15:171.
https://doi.org/10.1007/s11657-020-00754-z

IV. Kaijser Alin C, Grahn Kronhed A-C, Uzunel E, Salminen H. Wearing an activating spinal orthosis and physical training in women with osteoporosis and back pain – a post-intervention follow-up study. [Manuscript]