Osteoporosis program rehabilitates and educates

Small groups for individual teaching and support

The osteoporosis program at Haywood Regional Medical Center in Clyde, NC, was slightly ahead of its time. "Not many people were talking about osteoporosis in 1992," says Jane Lesesne, RN, BSN, CDT, Osteoporosis Center coordinator at Haywood.

That's why the program was a comprehensive education endeavor, not only targeting women and men who had developed the disease but also physicians and community members. The community needed to know who was at risk for osteoporosis and how to prevent the disease, and the physician had to know how to identify the disease and treat it, explains Lesesne. (To learn how the hospital made the community aware of osteoporosis, see story, above.)

According to the Washington, DC-based National Osteoporosis Foundation, bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a bump or a fall causes a fracture or a vertebra to collapse. Yet, the disease is prevalent. In the United States today, 10 million individuals already have osteoporosis, and 18 million more have low bone mass, placing them at increased risk for the disease. According to the foundation, 80% of those affected by osteoporosis are women.

A grant from the Duke University Endowment in Durham, NC, provided the funds for a bone densitometer and the design of the Comprehensive Osteoporosis Rehabilitation and Education (CORE) program.

"About six months after we obtained the grant, we started a rehab program similar to cardiac or diabetic rehab programs. We got the idea for our program from a poster presentation we saw at a meeting we attended and tailored it to our area," says Lesesne.

Patients are referred to the program by their physicians and meet one day a week for four weeks. They work in groups of up to five patients with a physical therapist, nurse, dietitian, and social worker. The first day, patients are individually assessed by each discipline so an individual rehabilitation plan can be designed. At the conclusion of the program, participants meet with the entire staff for a summary evaluation and home treatment plan. (To see the role of each discipline in the education process, see story, above.)

Also, on the first day, patients attend a group class to learn the basics of osteoporosis such as the physiology of the disease and treatments.

Patients take a medical outcomes survey at the beginning and end of the program to help staff evaluate their improvement and design a home treatment plan. They are also given a pre- and post-questionnaire to see how much they learned during the program. Follow-up sessions are scheduled at three months, six months, and then yearly to adjust and evaluate therapy. (See copies of the medical outcomes survey and questionnaire inserted in this issue.)

"On the last day, we end with exit interviews so each patient knows where he or she is strong and what needs to be worked on," says Lesesne.