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The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures–a systematic review of the literature
SVENSSON, HILDA, OLSSON, LARS-ERIC, HANSSON, TOMMY, KARLSSON, JÓN, HANSSON-OLOFSSON, ELISABETH
Artikel i tidskrift (Refereegranskat)
Vertebral compression fracture (VCF) is a common fragility fracture and the starting point of a lasting, painful, disabling condition. The aim was to summarize the evidence of person-centered/non-medical interventions supporting women with VCF. Results show small numbers of studies with only probable effect onfunction, pain, QoL, fear of falling, and psychological symptoms. The vertebralcompression fracture (VCF) caused by osteoporosis is the third most common fragility fracture worldwide. Previously, it was believed that the pain caused by VCF was self-subsiding within weeks or a few months post-fracture. However, this positive prognosis has been refuted by studies showing that, for the great majority of patients, the VCF was the starting point of a long-lasting, severely painful, and disabling condition. The low number of studies focusing on the experience of the natural course of VCF, and what support is available and how itis perceived by those affected, calls for further investigation. Strengthening older patients' sense of security and increasing confidence in their ownabilities are of great importance for successful rehabilitation following VCF. More research is needed to identify resources, possibilities, and strategies that can assist older patients to reach their goals to improve well-being. The purposeof this systematic review was to identify and summarize the current evidence ofperson-centered or other structured non-medical/non-surgical interventions supporting older women after experiencing an osteoporotic VCF. A systematic literature search was conducted on the MeSH terms encompassing osteoporosis andvertebral compression fractures in the PubMed-MEDLINE and Cumulative Index forNursing and Allied Health Literature (CINAHL) databases during March through June 2015. The initial search identified 8789 articles, but only seven articles (sixrandomized controlled trials and one observational study with a control group)met the inclusion criteria. It became evident from the current study that theavailability of evidence on the effects of non-medical interventions aiming tosupport older women with VCF is limited, to say the least. The trials included inthis review have few limitations and were mainly considered to be of moderatequality. This systematic literature review suggests that non-medical interventions aiming to support older women with VCF might decrease levels ofpain and use of analgesic as well as promote improved physical mobility andfunction. These interventions would probably result in an improved difference in experiences of fear of falling and perceived psychological symptoms, but would only slightly improve quality of life. However, given the nature of the seven studies, potential biases in patient selection, issues around precision with small cohorts, and failure to control for confounders, makes it difficult to drawa definitive conclusion about the significant effects of non-medical interventions. Incurring a VCF is a complex and diverse event, necessitating equally complex interventions to identify new ways forward. However, to date,interventions struggle with a risk of selection bias in that only the needs of the healthiest of the population are addressed and the voices of the remaining majority of the people affected by VCF are unheard. © 2017, The Author(s).
Nyckelord: Nursing; Osteoporotic vertebral compression fracture; Supportive interventions