5. Discussions
VCFs, pulmonary disease, Pain, pain
PULMONARY DISEASE, BLIND
This study examined the effects of a rehabilitation program combined with pain management targeting pain perception and activity avoidance on multifaceted outcome measures in hospitalised older patients with acute VCFs. Currently, there is insufficient evidence regarding the use of conservative treatment for acute VCFs [In our pain management program, the patients' rehabilitation goals were first set based on shared decision-making. Systematic reviews investigating the effectiveness of goal setting in rehabilitation settings have shown that goal setting can improve patient adherence to treatment regimens; however, evidence for improved outcomes remains inconsistent [Pain intensity, PCS magnification, and physical activity levels improved significantly in the intervention group compared to those in the control group. A systematic review revealed the effect of behavioural change interventions on physical activity levels in hospitalised patients, and the most common equipment used was accelerometers for feedback [Although pain rumination and helplessness in both groups improved significantly compared with the baseline, pain magnification improvement was detected only in the intervention group. Pain magnification indicates a heightened perception of the threat represented by pain symptoms [The 6-MWT, identified as exercise tolerance, showed a better improvement in the intervention group than in the control group. Although no studies have investigated the effects of rehabilitation programs on exercise tolerance in older patients with acute VCFs, previous studies have indicated that promoting an increase in daily physical activity using a pedometer was effective in improving the 6-MWT in patients with the pulmonary disease [Considering the low withdrawal rates in the intervention group, it is suggested that the physical activity pacing approach using pedometers and a diary can be widely accepted by older patients with acute VCFs and is a safe and feasible pain management program. In addition, patients in the intervention and control groups had effectively improved pain, physical performance measures, ADL, QOL, and physical activity levels. These improvements are considered to result from the effects of the usual rehabilitation program, conservative treatment, and natural course of recovery from acute VCFs.This study has several limitations. First, it lacks blinding. We could not choose patients blindly when deciding to assign them to either the intervention or control group, which was impossible because of the nature of the intervention. It was quite difficult to blind the physical therapists who intervened because the intervention was easily recognised. Furthermore, the same physical therapist assessed all patients who participated in the intervention program. Therefore, our results may have been influenced by physical therapists' expertise and/or reporting bias. However, all the physical therapists who participated in this study received a similar level of training before the study. Thus, we believe that the physical therapist's expertise had a minimal effect on this study. Second, in the intervention group, the ratio of the 