Applicability of Vfrac in men: a qualitative study of an osteoporotic vertebral fracture screening tool for use in older people with back pain

Summary: The Vfrac clinical screening tool was developed to help primary care healthcare practitioners decide if an older woman with back pain is at high risk of a vertebral fragility fracture (VFF) and requires a spinal radiograph to confirm diagnosis. The Vfrac tool developmental work was carried out in women because of the higher background prevalence of VFF. We now wish to assess Vfrac in men. Purpose: To understand and characterise pain symptoms of men with VFF, and to evaluate the wording of the Vfrac tool from men’s perspective, to establish if a gender specific version of the Vfrac tool was needed. Methods: Individual interviews were conducted with 15 men using an interview topic guide based on the original Vfrac topic guide with the addition of a ‘think aloud’ section to discuss the wording of the current questions within the Vfrac tool. Thematic analysis was conducted by two researchers. Results: Seven themes highlight that that physical measurements can be potentially upsetting for those being measured(‘Weighed, measured and found wanting’); that closed questions cannot capture the complexity of experience (There isn’t room on the paper; pain is dynamic, not static; Walking can make it better or worse; well, it depends on which chair); and that gendered roles are varied and dynamic (I try to do my share of domestic work; No more Do-it-yourself). Conclusions: This research has allowed the male perspective of osteoporosis to be heard and importantly identified that the Vfrac tool had no gender specific barriers.