Developing and evaluating physiotherapy rehabilitation interventions for people with vertebral fragility fractures

Vertebral fragility fractures (VFF) are a common consequence of osteoporosis and are associated with pain, reduced physical function, impaired quality of life, and increased risk of further fractures and falls. In 2010, physiotherapy was an established treatment, but there was limited evidence about which interventions were safe and effective or about key outcome measures. This thesis is based on a coherent programme of research conducted from 2010 to 2025, that addressed the development, measurement and evaluation of physiotherapy for people with VFF. It critically examines five related publications. It discusses initial methodological research evaluating the validity of the Timed Loaded Standing (TLS) test as a measure of back muscle endurance for people with VFF. The findings underpinned the use of TLS in subsequent randomised controlled trials (RCTs). The central component is the design and conduct of a large, pragmatic RCT (the PROVE trial) that evaluated the effectiveness of manual therapy and exercise therapy compared with a single session of physiotherapy education for people with VFF. Whilst significant short-term improvements were observed in a range of outcomes that would be considered clinically important, these were not sustained at 12-months. This thesis appraises the trial methods and findings and considers exercise adherence as a key challenge and critical mechanism for sustaining benefits. Finally, this thesis examines research focused on the development and refinement of a complex, physiotherapist-led exercise adherence intervention for people with VFF, and the design of a RCT to test the intervention’s efficacy. Collectively, this body of work has advanced the evidence base for physiotherapy rehabilitation and the measurement of physical outcomes in people with VFF. It had important implications for clinical practice, research design, and physiotherapy provision for this growing and underserved patient population.

Name dc:type.qualificationname

Ph.D by Published Work

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

Oxford Brookes University

Author dc:creator

• Newman, Meredith Anne

Advisors dc:contributor.advisor

• Williams, Mark
• Barker, Karen

DOI dc:identifier.doi

https://doi.org/10.24384/118b-np49

OAI record oai:identifier

https://radar.brookes.ac.uk/radar/oai?verb=GetRecord&metadataPrefix=uketd_dc&identifier=tle%3A1dca92df-1837-4fe3-8757-311c6e22a133%3Ad6bd9758-527a-46cd-bfe2-c433766e8fca%3A1