Physiotherapy pathways in the oxfordshire fracture prevention service: a review of non-pharmacological outcomes for vertebral fracture patients

Susan Morris; Helen Stevens; Rachel Eckert; Patsy Stevens; Jane Kelly; Joanne Livingstone; Danielle Bishop; Jacalyn Elliott; Karen Taylor; MK Javaid; Sarah Connacher

doi:10.1530/obabs.08.P35

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Bone Abstracts (2026) 8 P35 | DOI: 10.1530/obabs.08.P35

OP2026 Poster Presentations Clinical Audits and Service Improvements (40 abstracts)

Physiotherapy pathways in the oxfordshire fracture prevention service: a review of non-pharmacological outcomes for vertebral fracture patients

Susan Morris ¹ , Helen Stevens ² , Rachel Eckert ¹ , Patsy Stevens ¹ , Jane Kelly ¹ , Joanne Livingstone ¹ , Danielle Bishop ¹ , Jacalyn Elliott ¹ , Karen Taylor ¹ , MK Javaid ^1,3 & Sarah Connacher ¹

Author affiliations

¹Oxfordshire Fracture Prevention Service, Oxford University Hospitals NHS Trust, Oxford, United Kingdom;²Department of Physiotherapy, Oxford University Hospitals NHS Trust, Oxford, United Kingdom;³NDORMS, University of Oxford., Oxford, United Kingdom

Background: High-risk osteoporotic patients commonly present with vertebral fractures, resulting in pain, height loss, postural changes, and reduced mobility, confidence, and quality of life. The Fracture Liaison Service (FLS) provides individual assessments, recommending bone-protective therapy and referral to specialist physiotherapists to reduce pain and optimise function. Physiotherapy offers non-pharmacological benefits through targeted exercises that improve strength and posture and provides opportunities for peer support, helping patients with similar conditions to enhance daily activities and social wellbeing.

Methods: In 2025, the FLS identified patients with vertebral fractures from DXA/ VFA and using the Nanox-AI Health VCF algorithm. Using electronic patient record screening, those referred for acute hospital-based physiotherapy were included; patients without a referral or those directed to community services were excluded. Pain (VAS) and health-related quality of life (EQ-5D-5L) were measured at initial assessment, follow-up appointments, and discharge. The aim was to evaluate outcome trends, identify gaps in service delivery, and assess the effectiveness of non-pharmacological physiotherapy interventions in this high-risk group.

Results: Of the 798 patients only thirty patients were referred for physiotherapy; 11 (37%) attended the structured Osteoporosis Group Class with hydrotherapy, and 19 (63%) received one-to-one physiotherapy. Engagement varied: two patients (7%) did not attend any sessions, and one patient (3%) self-discharged early. Follow-up VAS scores were available for only eight patients (27%), highlighting substantial gaps in outcome data. All patients with complete pre- and post-treatment VAS scores (n8) showed improvement in worst-pain VAS. However, low data completeness, particularly for EQ-5D-5L, limited assessment of broader functional or quality-of-life outcomes. Overall, individual physiotherapy was used more frequently (63%) than class-based intervention (37%). Missed appointments, incomplete scoring, and limited follow-up reduced the evaluability of both pathways.

Conclusions: Despite back pain and physiotherapy considered a core component of VF management, very few patients were referred to physiotherapy. Clarification of indications for physiotherapy referral between FLS and Physiotherapy teams, alongside standardised electronic documentation, is needed to improve data quality and support clearer evaluation of non-pharmacological interventions.