Archives of Osteoporosis

, Volume 5, Issue 1–2, pp 101–110 | Cite as

Professional views on patient education in osteoporosis

Original Article



The aim of this study was to investigate patient education in osteoporosis, with a consensus-building Delphi survey. The results showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain.


According to the World Health Organization, osteoporosis is a major health problem. The morbidity is caused by fractures associated with pain and decreased physical function, social function and well-being. The aim of this study was to investigate and reach consensus about how so-called osteoporosis schools are run by professionals in Sweden with a focus on intervention and evaluation.


The study design was a consensus-building, three-round Delphi survey. Questionnaires were sent by web and post to an expert panel comprising 15 nurses, occupational therapists and physiotherapists. In round 1, they were asked to write descriptions within the frame of eight domains related to intervention and evaluation. In the second and third rounds, the Delphi panel was asked to mark on a Likert scale the importance of 40 statements within these domains.


The answers showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. The schools comprise theoretical elements as well as practical exercises. Patients with fractures related to osteoporosis are offered participation. There is a lack of a theoretical basis, as well as of evidence, for present treatment models. Evaluation ought to be done systematically, and for this purpose, different questionnaires are used. Experts assert that evaluations show that patients gain increased activity levels, function, knowledge about osteoporosis, empowerment and pain reduction.


Consensus was reached in 29 of 40 items.


Cross-professional Delphi technique Fractures Patient education 


Conflict of interest

There is no conflict of interest in this original article.


  1. 1.
    WHO (1994) Technical report series. Assessment of Fracture Risk and its Application to Screening for Post-Menopausal Osteoporosis No 843. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Gold D, Silverman S (2004) Osteoporosis self-management: choices for better bone health. South Med J 97:551–554CrossRefPubMedGoogle Scholar
  3. 3.
    Pedretti LW, Schultz Krohn W (2006) Pedretti’s occupational therapy: practice skills for physical dysfunction. Mosby Elsevier, St. LouisGoogle Scholar
  4. 4.
    SBU (2003) Osteoporos prevention, diagnostik och behandling [osteoporosis: prevention, diagnostics and treatment]. Statens beredning för medicinsk utvärdering, StockholmGoogle Scholar
  5. 5.
    Swedenmyr F, Lindström I (2006) Regionalt vårdprogram för osteoporos [Regional Care Plan for Osteoporosis]. Centrum för hälso- och sjukvårdsanalys, rapport nr 20. Västra GötalandsregionenGoogle Scholar
  6. 6.
    Ekström H (2009) The influence of fracture on activity, social participation & quality of life among older adults. Results from the population study Good Ageing in Skåne. Dissertation, Lund UniversityGoogle Scholar
  7. 7.
    Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16:447–455CrossRefPubMedGoogle Scholar
  8. 8.
    Vujasinovic’-Stupar N, Radunovic’G SM (2005) Quality of life assessment in osteoporotic patients with and without vertebral fractures. Med Pregl 58:453–458CrossRefGoogle Scholar
  9. 9.
    Nielsen D, Ryg J, Nissen N, Nielsen W, Knold B, Brixen K (2008) Multidisciplinary patient education in groups’ increases knowledge on osteoporosis: a randomized controlled trial. Scand J Public Health 36:346–352CrossRefPubMedGoogle Scholar
  10. 10.
    ICF (2003) International classification of functioning, disability and health. Socialstyrelsen [The National Board of Health and Welfare], StockholmGoogle Scholar
  11. 11.
    Fisher AG (2009) Occupational therapy intervention process model—a model for planning and implementing top-down, client-centred, and occupation-based interventions. Three Star, Fort CollinsGoogle Scholar
  12. 12.
    Elinge E, Löfgren B, Gagerman E, Nyberg L (2003) A group learning programme for old people with hip fracture: a randomized study. Scand J Occup Ther 10:27–33CrossRefGoogle Scholar
  13. 13.
    SBU (2009) Nationella riktlinjer för diabetes, preliminär version [National guidelines for diabetes, preliminary version] Statens beredning för medicinsk utvärdering, Stockholm
  14. 14.
    Schousboe JT, De Bold RC, Kuno LS, Weiss TW, Chen YT, Abbott TA (2005) Education and phone follow-up in postmenopausal women at risk for osteoporosis. In: Dis Manage Health Outcomes. Available at Adis Data Information BV 13:395-404 <>
  15. 15.
    Wilcock A (2006) An occupational perspective of health. NJ Slack, ThorofareGoogle Scholar
  16. 16.
    Bonaiuti D, Shea B, Iovine R, Negrini S, Robinson V, Kemper HC, Wells G, Tugwell P, Cranney A (2005) Exercise for Preventing and Treating Osteoporosis in Postmenopausal Women. Available via the Cochrane Library. Accessed 22 April 2002 doi:10.1002/14651858.
  17. 17.
    Information från Läkemedelsverket 2 (2004) Behandling av osteoporos för att förebygga frakturer [Treating osteoporosis to prevent fractures]. Läkemedelsverket, UppsalaGoogle Scholar
  18. 18.
    Keeney S, Hasson F, McKenna H (2006) Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs 53:205–212CrossRefPubMedGoogle Scholar
  19. 19.
    Burns SP, Rivara FP, Johansen JM, Thompson DC (2003) Rehabilitation of traumatic injuries: use of the Delphi method to identify topics for evidence-based review. Am J Phys Med Rehabil 82:410–414CrossRefPubMedGoogle Scholar
  20. 20.
    Vasquez-Ramos R, Leahy M, Hernandez NE (2007) The Delphi method in rehabilitation counselling research. Rehabil Couns Bull 50(111–118):121–124Google Scholar
  21. 21.
    Weigl M, Cieza A, Andersen C, Kollerits B, Amann E, Stucki G (2004) Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise. J Rehabil Med 44:12–21CrossRefPubMedGoogle Scholar
  22. 22.
    Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32:1008–1015PubMedGoogle Scholar
  23. 23.
    Clayton M (1997) Delphi: a technique to harness for critical decision making tasks in education. J Educ Psychol 17:373–386CrossRefGoogle Scholar
  24. 24.
    Powell C (2003) The Delphi technique: myths and realities. J Adv Nurs 41:376–382CrossRefPubMedGoogle Scholar
  25. 25.
    Whitman N (1990) The committee meeting alternative: using the Delphi technique. J Nurs Adm 20:30–36PubMedGoogle Scholar
  26. 26.
    DePoy E, Gitlin LN (1999) Forskning: en introduktion [research: an introduction]. Studentlitteratur, LundGoogle Scholar
  27. 27.
    Mary E, Hurley R (1986) Nursing diagnosis: validation. The sixth conference. CV Mosby, St Louis, pp 183–190Google Scholar
  28. 28.
    Svensson E (2001) Guidelines to statistical evaluation of data from rating scales and questionnaires. J Rehabil Med 33:47–48CrossRefPubMedGoogle Scholar
  29. 29.
    McKenna HP (1994) The Delphi technique: a worthwhile approach for nursing? J Adv Nurs 19:1221–1225CrossRefPubMedGoogle Scholar
  30. 30.
    Sumsion T (1998) The Delphi technique: an adaptive research tool. Br J Occup Ther 61:153–156Google Scholar
  31. 31.
    Vetenskapsrådet och CODEX (2008) Centrum för forsknings- och bioetik.
  32. 32.
    Adler M, Ziglio E (1996) Gazing into the oracle—the Delphi method and its application to social policy and public health. Cromwell, MelkshamGoogle Scholar
  33. 33.
    Sadhra S, Beach JR, Aw TC, Sheikh-Ahmed K (2001) Occupational health research priorities in Malaysia: a Delphi study. Occup Environ Med 58:426–431CrossRefPubMedGoogle Scholar
  34. 34.
    Van Steenkiste BC, Jacobs JE, Verheijen NM, Levelink JH, Bottema BJAM (2002) A Delphi technique as a method for selecting the content of an electronic patient for asthma. Int J Med Inform 65:7–16CrossRefPubMedGoogle Scholar
  35. 35.
    Flink A, Kosecoff J, Chassin M, Brook RH (1987) Consensus methods: characteristics and guidelines for use. Am J Public Health 74:979–983CrossRefGoogle Scholar
  36. 36.
    Williams PL, Webb C (1994) The Delphi technique: a methodological discussion. J Adv Nurs 19:180–186CrossRefPubMedGoogle Scholar
  37. 37.
    Meehan T, Glover H (2009) Using the quality improvement knowledge inventory (RKI) to assess the effectiveness of a consumer-led quality improvement training program for service providers. Psychiatr Rehabil J 32:223–226CrossRefPubMedGoogle Scholar
  38. 38.
    Cabral D, Katz JN, Weinblatt ME, Ting G, Avorn J, Solomon DH (2005) Development and assessment of indicators of rheumatoid arthritis severity: results of a Delphi panel. Arthritis Rheum 53:61–66CrossRefPubMedGoogle Scholar
  39. 39.
    Linstone HA, Turoff M (1975) The Delphi method—techniques and applications. Addison-Wesley, ReadingGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  1. 1.Reg OT, FoU Sjuhärad VälfärdUniversity of BoråsBoråsSweden
  2. 2.School of Health Sciences, Department of RehabilitationJönköping UniversityJönköpingSweden

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