Physical Therapy
We are unable to recommend for or against a supervised or unsupervised exercise program for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Rationale
A single Level II study evaluated fractures with low back pain of greater than 3 months’ duration using a home-based exercise program compared to a control group continuing usual activities using the Osteoporosis Quality of Life Questionnaire, which evaluates 5 domains.68 We downgraded this recommendation to inconclusive because the low back pain experienced by patients in this study may not be the direct result of a specific spinal compression fracture. Results did favor exercise to improve the symptom domain at 6 and 12 months and the emotion domain at 6 months but not at 12 months. There was no difference in the physical function domain at 6 or 12 months. When evaluating the domain of activities of daily living there was no difference at 6 months but there was evidence favoring exercise at 12 months. In evaluating the leisure/social domain there was evidence to support exercise at the 6 month level but no difference at the 12 month level. The clinical importance of these outcomes is unknown. There was no documentation that the back pain measured was a direct result of the fracture.