Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial.
OBJECTIVE
To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures (VFs).


METHODS
Randomized, controlled trial (modified cross-over) with site as unit of assignment; testing at baseline and 3, 6, 9, and 12 months.


METHODS
Nine North Carolina retirement communities.


METHODS
One hundred eighty-five postmenopausal Caucasian women (mean age 81), each with at least one VFs.


METHODS
The intervention group had 6 months of exercise (3 meetings weekly, 45 minutes each) and coping classes (2 meetings weekly, 45 minutes each) in Phase 1, followed by 6 months of self-maintenance. The control group had 6 months of health education control intervention (1 meeting weekly, 45 minutes) in Phase 1, followed by the intervention described above.


METHODS
Change in trunk extension strength, change in pain with activities, and change in psychological symptoms.


RESULTS
Between-group differences in the change in trunk extension strength (10.68 foot pounds, P<.001) and psychological symptoms (-0.08, P=.011) were significant for Phase 1. Changes in pain with activities did not differ between groups (-0.03, P=.64); there was no change in the pain endpoint. In Phase 2, controls showed significant changes in trunk strength (15.02 foot pounds, P<.001) and psychological symptoms (-0.11, P=.006) from baseline. Change in pain with activities was not significant (-0.03, P=.70). During self-maintenance, the intervention group did not worsen in psychological symptoms, but improved trunk extension strength was not maintained.


CONCLUSIONS
Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment, and psychological improvements are retained for at least 6 months.
Gold
Deborah T
DT
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA. dtg@geri.duke.edu
Shipp
Kathy M
KM
Pieper
Carl F
CF
Duncan
Pamela W
PW
Martinez
Salutario
S
Lyles
Kenneth W
KW
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005081:Exercise Therapy / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008603:Mental Health; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009657:North Carolina; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010353:Patient Education as Topic / Q000458:organization & administration*; D012657:Self-Help Groups / Q000458:organization & administration*; D016103:Spinal Fractures / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D013909:Thorax; D016896:Treatment Outcome