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Osteoporosis is a condition where bones lose strength and break easily. Symptoms of osteoporosis and spinal fractures include back pain, stooped posture, reduced balance, and difficulty carrying out everyday activities. Studies suggest exercises prescribed by a physiotherapist can be helpful, but also that people often find it difficult to stick to an exercise programme. Various behavioural techniques like using an exercise diary can encourage exercise habits but to be most effective it seems important to use techniques that suit a person's lifestyle.

We are undertaking a study to test if physiotherapy exercise treatment plus a personalised programme of techniques to encourage people to do their exercises regularly is of more benefit to patients compared to physiotherapy exercises alone. We want to understand if adding support techniques improves patient well-being, physical function, fear of falling and exercise participation.


We are undertaking research to improve the physiotherapy treatment of adults with spinal fractures due to osteoporosis who experience back pain. Studies suggest physiotherapy exercises can help, but also that people can find it difficult to stick to an exercise routine. We have developed an intervention which combines physiotherapy exercise treatment with a personalised package of behavioural techniques that encourage people to exercise. We will evaluate this in a randomised controlled trial.


Vertebral fractures due to osteoporosis are common and affect at least 20% of adults over 55 in the UK. They are associated with back pain, fatigue, excess spinal curvature, balance problems, falls, mobility decline and reduced independence and quality of life.
Current treatment includes bone-protective medications and lifestyle adaptation. Guidelines recommend people keep active and there is increasing evidence that exercises prescribed by a physiotherapist are safe and can be of benefit. Conversely, there is also evidence that people find it difficult to adhere to exercise treatments and that this can limit their benefits. Multiple factors can affect adherence e.g., lack of confidence with exercise, fear of falls, pain, time constraints.

Considering this, developing interventions that support people to engage with physiotherapy exercise treatment seem important to providing effective rehabilitation. We suspect these need to be tailored to the individual patient.

Aims and objectives

1) To compare physiotherapy exercise rehabilitation with adherence support, to physiotherapy exercise rehabilitation alone in terms of its effects on:

a) Physical function, quality of life and fear of falling.
b) Exercise self-efficacy and adherence.

2) To explore patient and physiotherapist views of the intervention and of adhering to exercise.

3) To understand if physiotherapy exercise rehabilitation with adherence support is cost effective. 

Study design

A multi-centre randomised controlled trial with an embedded qualitative study and health economics analysis.


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