Functional progression in post-osteoporotic fracture: A case study

Introduction: Osteoporosis is characterized by a loss of bone mass along with alterations in its structure, with subsequent increase in bone fragility and susceptibility to fractures, ultimately reinforcing the importance of its prevention by the reduction of the risk of falling. In this paper we propose to analyze the functional progression of a patient, integrated in a multidisciplinary program (TOMBO-Therapeutic Occupational Multidisciplinary approach to the Benefi t of Osteoporosis), after an osteoporotic fracture. Methods: Retrospective descriptive case-study of the fi rst patient included in the TOMBO program. Data were gathered for Time Up and Go Test (TUGT), Sit to Stand in 30 secs. (SS-30), 10m Walking Test (10m-WT), Barthel Index (BI) and Morse Scale (MS) in 3 different moments: baseline (ward, at discharge: M0), 2 and 6-months after surgery (multidisciplinary appointments: MD2, MD6). Results: TUGTM0: no capability; MD2: 18,8 secs.; MD6: 8 seg. SS-30 M0: no capability; MD2: 9 stands; MD6: 10 stands. 10m-WT M0: 30 secs.; MD2: 13 secs.; MD6: 8 secs. BI M0: 60; MD2, 80; MD6: 100. MS M0: 85, MD2: 50; MD6: 15. Conclusion: This case-study revealed us that the fi rst patient admitted to this innovative multidisciplinary approach improved some functional parameters (level of dependency and risk of falling) as shown by its favorable progression on the tests and scales applied.c Research Article Functional progression in post-osteoporotic fracture: A case study Sérgio Caseiro1, Paula Rocha1, Isabel Neves1, Carlos Pontinha1, Ana Rita Batista1, Gina Monteiro1, Luís Matos2*, Filipe Cunha Santos3, Ana Sofi a Pinto3, Sara Paiva Dinis3, Joana Ferreira3 and Cláudia Vaz4 1Rehabilitation Nurse Specialist, Orthopedics ward, Local Health Unit of Guarda, Portugal 2Nutritionist, Head of Nutrition Unit, Local Health Unit of Guarda, Portugal 3Rheumatologist Resident, Local Health Unit of Guarda, Portugal 4Rheumatologist MD, Local Health Unit of Guarda, Portugal Received: 27 February, 2021 Accepted: 16 March, 2021 Published: 17 March, 2021 *Corresponding author: Luis Rego Costa Matos, Nutritionist, Director of the Nutrition Service, E.P.E. Local Health Unit of Guarda, Portugal, Tel: +351 271 210 840; Fax: +351 271 223 104; E-mail: ORCID: https://orcid.org/0000-0002-2396-7367


Introduction
Osteoporosis is a "systemic skeletal disease characterized by the loss of bone mass and impaired micro-architecture of bone tissue, with subsequent increase in bone fragility and susceptibility to fracture" [1].
At advanced age, most fractures result from low-impact events, ultimately reinforcing the importance of its prevention by the reduction of the risk of falling [2]. Current literature points out the benefi t of implementing exercise programs along with security home measures, as a way to contribute to decrease this risk [3,4].
Taking this into account, and fi lling up an existing gap in the diagnosis and treatment of osteoporosis, with special focus on secondary prevention, we develop TOMBO program -Therapeutic Occupational Multidisciplinary approach to the Benefi t of Osteoporosis. Its innovative feature is that congregates a multidisciplinary team of Rheumatologists, Rehabilitation Nurses and Nutritionist. This multidisciplinary approach adds value to treatment and monitoring of these Assessment tools used in different moments of the rehabilitation process allow us to gather precise data on functional progression as well as risk of falling. To this respect, multiple instruments have been created and used along the years but we selected those that perform the best to this end [5].
This well-planned structure optimizes existing resources and simultaneously improves healthcare quality of services [6,7].

Methodology
A retrospective and descriptive case study analysis was performed. Inclusion criteria for TOMBO program are patients aged <90 years, with low-impact femur fracture and with potential for mobility rehabilitation after surgery.
We applied the following measuring scales and instruments: Inclusion criteria for TOMBO program were met. The program was readily initiated by the rehabilitation nursing staff, which engaged with a health literacy session (included hand-delivery of a "Fall Prevention and Osteoporosis" fl yer) and applied evaluation scales abovementioned.
After hospital discharge, the patient was then monitored in moments MD2 and MD6. In both these moments the rehabilitation nurse approach consisted in the projection and visualization of videos allusive to osteoporosis and fall prevention, in the demonstration and train-assisted musculoarticular exercises for the lower and upper limbs (active, active-assisted and resistive) and in the gait training with the level of support needed for the patient's ability in casu.
Another fl yer was hand-delivered "Osteoporosis -Exercise Guide", in order to ensure exercise plan continuity at home.
Also, evaluation scales were reapplied as planned.

Results
This patient improved his scores in every test performed, refl ecting a positive and favorable progression in physical ability and functional independence and lower risk of falling, as expected. At discharge he was not able to perform TUGT nor SS-30s.
Results are summed up in Table 1. In this approach, through the optimization of existing resources, an intervention was developed at the level of the implementation of a rehabilitation / exercise plan, a nutritional care plan, and a pharmacological therapeutic plan for osteoporosis / secondary prevention, which came to add value to the treatment and accompanying thus, improving the quality of health services provided.

Conclusion
The present study revealed that the patient who suffered an osteoporotic fracture and who was included in the TOMBO Program benefi ted from an innovative and multidisciplinary approach, in which the Rehabilitation Nurse had a relevant role in the different moments of implementation (hospitalization and multidisciplinary appointments), having presented an improvement in functional independence and a decrease in the risk of falls, refl ected in the favorable evolution of the tests and scales applied.
We suggest that, in the future, it should necessarily be implemented in larger populations with similar characteristics, and consequently study its impact.