5. Discussion
chronic musculoskeletal pain, pain, finger fracture, injuries, osteoporosis
CHRONIC PAIN, OSTEOPOROSIS
The present study shows that patient education, including interdisciplinary themes, combined with supervised training is a well-accepted and safe intervention in a primary health care cohort of patients with established spinal osteoporosis. The intervention had positive effects on important health outcomes, including chronic pain, physical function, and HRQoL. Adherence to the once-weekly intervention program for ten weeks was high, with a mean attendance rate of 90%, even though several participants lived far away from where the SOL interventions took place.Most VFs are painful and cause persistent symptoms [Concerning the importance of observing and teaching the individuals within the groups, an upper limit of 8 to 10 participants is desirable [A multi-component exercise program with progressive strength resistance and balance training, which was performed by the TPh group, is recommended for people with osteoporosis [Most of the physical exercise training and the MMY training was safe. However, one finger fracture occurred in the TPh group, when exercising with a medicine ball. This specific exercise could be adjusted in the future to diminish the risk of injuries in this patient group.Previous studies on patient education in osteoporosis have shown inconsistent results on quality of life, maybe due to various interventions and study designs [The one-leg stance with eyes closed was improved for all participants as a group but, when the subgroups were analyzed, only the TPh group had significant improvements in this test. However, there was no improvement in the one-leg stance with the eyes open. We experienced that the limit for the one-leg stance with the eyes open could be extended to 60 s, as many of the participants managed 30 s, which could make the outcome measure less sensitive. The chair-stand was improved in the TMMY group, maybe as a result of an actual improvement or a more confident patient after the supervised mindfulness/medical yoga training [To our knowledge, this is the first study using the PEI to measure patient enablement in patients with osteoporosis. The mean PEI total score with a range of 0-12 was 4.1 post-intervention, which is a similar improvement compared to another Swedish study investigating patient enablement in patients with chronic musculoskeletal pain after intervention [The power of this pilot study makes subgroup analysis uncertain, but some trends could be seen, including the additive effect when including physical training in the patients’ education. However, the pure T group was very small, with a risk of rejecting true improvements. With this perspective, it is still important to include a pure T group when designing RCTs. In addition, theory education could more easily be implemented through a digital osteoporosis school. A sample size calculation with “pain last week” as the primary outcome and a 20% reduction after an intervention show a need for at least 17 participants in each arm.In the study design, we also included a non-interventional observation period prior to the interventions. We initially intended to conduct the study with a control arm without patient education interventions, i.e., similar to how osteoporosis health care is arranged in many areas today. However, after some critical reviews from the ethical committee, we chose to let all participants have an active arm and added the preceding observation period. Analyses of these pooled data showed stable results regarding most variables strengthening the observations that the changes seen after intervention are effects of the SOL. In the observation period, the distance C7-wall was improved but did regress to the baseline values after the interventions. We believe that this was not a true change but a weakness of the test, i.e., too little precision from using a folding ruler to make the correct measurements. The general unaltered results during the observation period indicate that a non-interventional arm might be unnecessary for a future larger RCT.The informants in the TPh group, as well as participants in the other intervention groups, asked for supervised physical group training after the SOL, which was planned to begin in January 2020. Unfortunately, this training was impeded due to the lockdown caused by the COVID-19 pandemic.