Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

doi:10.1186/s12891-016-1227-0

Randomized Controlled Trial

. 2016 Aug 26;17(1):369.

doi: 10.1186/s12891-016-1227-0.

Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

Stephanie W Edmonds^{1

2}, Peter Cram^{3

4}, Yiyue Lou⁵, Michael P Jones^{5

6}, Douglas W Roblin^{7

8}, Kenneth G Saag⁹, Nicole C Wright¹⁰, Fredric D Wolinsky^{11

12

13}; PAADRN Investigators

Collaborators, Affiliations

Collaborators

PAADRN Investigators:
JeffreyR Curtis, SarahL Morgan, JanetA Schlechte, DavidJ Zelman

Affiliations

¹ Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
² College of Nursing, University of Iowa, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
³ Department of Medicine, University of Toronto Division of General Internal Medicine, Toronto, ON, Canada.
⁴ University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
⁵ College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA.
⁶ Iowa City Veterans Affairs Health System, Iowa City, IA, USA.
⁷ Kaiser Permanente, Atlanta, GA, USA.
⁸ School of Public Health, Department of Health Management and Policy, Georgia State University, Atlanta, GA, USA.
⁹ Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁰ School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹¹ Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA.
¹² College of Nursing, University of Iowa, Iowa City, IA, USA.
¹³ College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa, IA, USA.

PMID: 27562713
PMCID: PMC5000520
DOI: 10.1186/s12891-016-1227-0

Randomized Controlled Trial

Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

Stephanie W Edmonds et al. BMC Musculoskelet Disord. 2016.

. 2016 Aug 26;17(1):369.

doi: 10.1186/s12891-016-1227-0.

Authors

Collaborators

PAADRN Investigators:
JeffreyR Curtis, SarahL Morgan, JanetA Schlechte, DavidJ Zelman

Affiliations

¹ Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
² College of Nursing, University of Iowa, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
³ Department of Medicine, University of Toronto Division of General Internal Medicine, Toronto, ON, Canada.
⁴ University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
⁵ College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA.
⁶ Iowa City Veterans Affairs Health System, Iowa City, IA, USA.
⁷ Kaiser Permanente, Atlanta, GA, USA.
⁸ School of Public Health, Department of Health Management and Policy, Georgia State University, Atlanta, GA, USA.
⁹ Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁰ School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹¹ Carver College of Medicine, Department of Internal Medicine, University of Iowa, 5231 Westlawn, IA 52242, Iowa City, IA, USA.
¹² College of Nursing, University of Iowa, Iowa City, IA, USA.
¹³ College of Public Health, Department of Health Management and Policy, University of Iowa, Iowa, IA, USA.

PMID: 27562713
PMCID: PMC5000520
DOI: 10.1186/s12891-016-1227-0

Abstract

Background: Undiagnosed, or diagnosed and untreated osteoporosis (OP) increases the likelihood that falls result in hip fractures, decreased quality of life (QOL), and significant medical expenditures among older adults. We tested whether a tailored dual energy x-ray absorptiometry (DXA) test result letter and an accompanying educational bone-health brochure affected patient satisfaction, QOL, or OP knowledge.

Methods: The Patient Activation after DXA Result Notification (PAADRN) study was a double-blinded, pragmatic, randomized trial which enrolled patients from 2012 to 2014. We randomized 7,749 patients presenting for DXA at three health care institutions in the United States who were ≥ 50 years old and able to understand English. Intervention patients received a tailored letter four weeks after DXA containing their results, 10-year fracture risk, and a bone-health educational brochure. Control patients received the results of their DXA per the usual practices of their providers and institutions. Satisfaction with bone health care, QOL, and OP knowledge were assessed at baseline and 12- and 52-weeks after DXA. Intention-to-treat analyses used multiple imputation for missing data and random effects regression models to adjust for clustering within providers and covariates.

Results: At 12-weeks 6,728 (86.8 %) and at 52-weeks 6,103 participants (78.8 %) completed their follow-up interviews. The intervention group was more satisfied with their bone health care compared to the usual care group at both their 12- and 52-week follow-ups (standardized effect size = 0.28 at 12-weeks and 0.17 at 52-weeks, p < 0.001). There were no differences between the intervention and usual care groups in QOL or OP knowledge at either time point.

Conclusions: A tailored DXA result letter and bone-health educational brochure sent to patients improved patient satisfaction with bone-related health care.

Trial registration: Clinical Trials.gov Identifier: NCT01507662 First received: December 8, 2011.

Keywords: Dual-energy x-ray absorptiometry; Health education; Osteoporosis; Quality of health care; Quality of life.

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Figures

**Fig. 1**
CONSORT Flow Diagram of PAADRN Study

See this image and copyright information in PMC

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References

1. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–2526. doi: 10.1002/jbmr.2269. - DOI - PMC - PubMed
1. US Department of Health and Human Services . Office of the Surgeon General. Rockville: US Department of Health and Human Services; 2004. Bone health and osteoporosis: a report of the Surgeon General.
1. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87(3):398–403. doi: 10.2105/AJPH.87.3.398. - DOI - PMC - PubMed
1. Doheny MO, Sedlak CA, Estok PJ, Zeller R. Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthop Nurs. 2007;26(4):243–250. doi: 10.1097/01.NOR.0000284654.68215.de. - DOI - PubMed
1. Cadarette SM, Gignac MA, Beaton DE, Jaglal SB, Hawker GA. Psychometric properties of the “Osteoporosis and You” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporos Int. 2007;18(7):981–989. doi: 10.1007/s00198-007-0326-z. - DOI - PubMed

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[1] Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–2526. doi: 10.1002/jbmr.2269. - DOI - PMC - PubMed

[2] Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–2526. doi: 10.1002/jbmr.2269. - DOI - PMC - PubMed

[3] US Department of Health and Human Services . Office of the Surgeon General. Rockville: US Department of Health and Human Services; 2004. Bone health and osteoporosis: a report of the Surgeon General.

[4] US Department of Health and Human Services . Office of the Surgeon General. Rockville: US Department of Health and Human Services; 2004. Bone health and osteoporosis: a report of the Surgeon General.

[5] Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87(3):398–403. doi: 10.2105/AJPH.87.3.398. - DOI - PMC - PubMed

[6] Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87(3):398–403. doi: 10.2105/AJPH.87.3.398. - DOI - PMC - PubMed

[7] Doheny MO, Sedlak CA, Estok PJ, Zeller R. Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthop Nurs. 2007;26(4):243–250. doi: 10.1097/01.NOR.0000284654.68215.de. - DOI - PubMed

[8] Doheny MO, Sedlak CA, Estok PJ, Zeller R. Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthop Nurs. 2007;26(4):243–250. doi: 10.1097/01.NOR.0000284654.68215.de. - DOI - PubMed

[9] Cadarette SM, Gignac MA, Beaton DE, Jaglal SB, Hawker GA. Psychometric properties of the “Osteoporosis and You” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporos Int. 2007;18(7):981–989. doi: 10.1007/s00198-007-0326-z. - DOI - PubMed

[10] Cadarette SM, Gignac MA, Beaton DE, Jaglal SB, Hawker GA. Psychometric properties of the “Osteoporosis and You” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporos Int. 2007;18(7):981–989. doi: 10.1007/s00198-007-0326-z. - DOI - PubMed

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Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

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Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

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