An online clinical decision tool to screen for vertebral fragility fractures (Vfrac) in older women presenting with back pain in general practice: protocol for a feasibility study in preparation for a future cluster randomized controlled trial

Khalid, Tanzeela Y; Peters, Tim J; Pocock, Lucy; Drew, Sarah; Hardcastle, Sarah; Paskins, Zoe; Davis, Sarah; Kariki, Eleni P; Clark, Emma

Abstract

Summary
This feasibility study for a future definitive randomized trial assesses the use and acceptability of a new clinical decision tool to identify risk of a vertebral fracture and those who should be referred for spinal radiography in women aged 65 or over presenting to primary care with back pain.

Purpose
Approximately 12% of older adults have vertebral fragility fractures, but currently fewer than one-third are diagnosed, potentially limiting access to bone protection treatment. Vfrac is a vertebral fracture screening tool which classifies individuals into high or low risk of having a vertebral fracture, allowing targeting of spinal radiographs to high-risk individuals. The objective of this study was to investigate the feasibility of conducting a cluster randomized controlled trial to evaluate the use of an online version of Vfrac in primary care.

Methods
The study will run in six general practices, with three given the Vfrac tool for use on older women (> 65 years) consulting with back pain and three using standard clinical processes for managing such back pain. Anonymised data covering a 12-month period will be collected from all sites on consultations by older women with back pain. Focus groups will be undertaken with healthcare professionals and patients on whom the tool was used to understand the acceptability of Vfrac and identify factors that impact its use. These patients will be sent a paper version of the Vfrac questionnaire to self-complete at home. Outputs of the self-completion Vfrac (high versus low risk) will be compared with the face-to-face Vfrac (high versus low risk), and agreement assessed using Cohen’s kappa.

Results
This study will evaluate the use and acceptability of Vfrac within primary care and determine if data on resource use can be collected accurately and comprehensively.

Conclusions
This article describes the protocol of the Vfrac feasibility study.

Citation

Khalid, T. Y., Peters, T. J., Pocock, L., Drew, S., Hardcastle, S., Paskins, Z., …Clark, E. (2024). An online clinical decision tool to screen for vertebral fragility fractures (Vfrac) in older women presenting with back pain in general practice: protocol for a feasibility study in preparation for a future cluster randomized controlled trial. Archives of Osteoporosis, 19, Article 12. https://doi.org/10.1007/s11657-023-01364-1

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2023
• Online Publication Date: Feb 7, 2024
• Publication Date: Feb 7, 2024
• Deposit Date: Dec 20, 2023
• Publicly Available Date: Dec 20, 2023
• Journal: Archives of Osteoporosis
• Print ISSN: 1862-3522
• Electronic ISSN: 1862-3514
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Article Number: 12
• DOI: https://doi.org/10.1007/s11657-023-01364-1
• Keywords: Vertebral fractures; Back pain; Osteoporosis; Vfrac
• Publisher URL: https://link.springer.com/article/10.1007/s11657-023-01364-1