Group Treatment Improves Trunk Strength and Psychological Status in Older Women with Vertebral Fractures: Results of a Randomized, Clinical Trial

Authors

  • Deborah T. Gold PhD,

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Kathy M. Shipp PT, PhD,

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Carl F. Pieper DrPH,

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Pamela W. Duncan PhD, PT,

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Salutario Martinez MD,

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Kenneth W. Lyles MD

    1. From the *Departments of Psychiatry and Behavioral Sciences, Sociology, and Psychology: Social and Health Sciences, Departments ofPhysical Therapy, Biostatistics and Bioinformatics, §Radiology, and Medicine, Claude D. Pepper Older Americans Independence Center and the Duke University Center for the Study of Aging and Human Development, #Sarah W. Steadman Center for Nutritional Studies, Duke University Medical Center, Durham, North Carolina**Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina††Brooks Center for Rehabilitation Studies and Department of Health Service Administration, University of Florida, Gainesville, Florida‡‡Rehabilitation Outcomes Research Center of Excellence, Veterans Affairs Medical Center, Gainesville, Florida.
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  • Support for this research was provided by NIH Grants AG-11269 and HD-30442 (Gold, Shipp, Pieper, Duncan, Lyles), AARP/Andrus Foundation Grant (Gold), Department of Veterans Affairs Medical Research Service (Lyles), Beazley Foundation Grant (Gold, Shipp, Lyles), and the Foundation for Physical Therapy, Inc. (Shipp).

Address correspondence to Deborah T. Gold, PhD, Box 3003, Duke University Medical Center, Durham, NC 27710. E-mail: dtg@geri.duke.edu

Abstract

Objectives: To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures (VFs).

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

Setting: Nine North Carolina retirement communities.

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

Intervention: 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.

Measurements: 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.

Conclusion: 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.

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