An Assessment of Treatment Adherence of Osteoporosis Patients From a Biopsychosocial Perspective

• ClinicalTrials.gov Identifier: NCT05943600
• Recruitment Status: Not yet recruiting
• First Posted: July 13, 2023
• Last Update Posted: July 13, 2023
• Sponsor: Istanbul University
• Collaborator: THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TÜRKİYE (TUBITAK)
• Information provided by (Responsible Party): Esin Temeloglu Sen, Istanbul University

Study Description

Brief Summary:

This observational study aims to learn about the psychosocial risk factors of osteoporosis (OP) patients. The main question it aims to answer is:

• Which biopsychosocial factors affect OP patients' fragility fracture risk regarding the health behaviour model? Participants will fulfil these forms below here;
• Sociodemographic and Clinical Information Form,
• Fragility Fracture Information Form
• Medication Adherence Report Scale
• Brief Illness Perception Scale
• The Beliefs About the Medicines Scale-Specific
• The Short Assessment of Patient Satisfaction
• Perceived Stress Scale
• Multidimensional Perceived Social Support Scale
• Brief Symptom Inventory - Depression and Anxiety
• Health Behavior Assessment Scale

Condition or disease
Osteoporosis; Osteoporotic Fractures; Psychosocial Functioning; Medication Adherence

Detailed Description:

Osteoporosis (OP) is a disease characterized by decreased bone density and deterioration of bone microarchitecture. Fracture risk, which is one of the most negative disease experiences faced by OP patients, can be seen in many parts of the body in the later stages of the disease. The necessity of interventions that prevent or delay fractures highlights severe orthopaedic surgeries, increasing health expenditures and psychosocial losses in the lives of individuals. The project will proceed through three objectives: researching the components that affect the fracture, developing an intervention and implementing it. According to the first aim, it has been seen in the current literature that the most effective method in preventing the risk of fracture is to increase the medication adherence (MA) of the patients. It is seen that the Self-Regulatory Model (SRM)-based studies, in which the components explaining the MA of OP patients are examined as a model, constitute one of the limited theory-based studies. However, the SRM, which stands out as an effective model in explaining MA with its components of "perception of illness" and "beliefs about the medicine", is thought to base the medication use experience only on individual validities. Hence, the concept of MA is also provided by the patient-doctor relationship. Therefore, the effect of patient satisfaction on MA will be discussed in the components of SRM. There are also psychosocial factors that are thought to affect the possible fracture apart from all these diseases and treatment-related components. There are findings that the fear of falling, anxiety and social withdrawal caused by OP increase the risk of a possible fracture. Accordingly, patients' psychological challenges may affect protective behaviours such as exercise and a calcium-rich diet, and smoking. Therefore, it is predicted that the psychological symptom levels of the patients will affect the fracture through health behaviours. Besides, OP can bring along stress just like other chronic diseases, and perhaps even more social support needs can be seen in these patient groups with other chronic diseases. Hence, the moderator effect of social support between the psychological symptom level of OP patients and their stress' constitutes another sub-research question of this study. It is aimed to develop a comprehensive multidisciplinary and evidence-based intervention that prevents possible fracture experiences in OP patients.

Study Design

• Study Type: Observational
• Estimated Enrollment: 585 participants
• Observational Model: Cohort
• Time Perspective: Cross-Sectional
• Official Title: An Assessment of Treatment Adherence of Osteoporosis Patients From a Biopsychosocial Perspective to Plan a Multidisciplinary Intervention Overcame Psychosocial Barriers
• Estimated Study Start Date: July 15, 2023
• Estimated Primary Completion Date: March 15, 2024
• Estimated Study Completion Date: April 15, 2026

Groups and Cohorts

Group/Cohort
Osteoporosis patients; Participants will fill out the self-report scales.

Outcome Measures

Primary Outcome Measures :

1. Medication Adherence Report Scale [ Time Frame: through study completion; approximately 9 months ]
   This scale will be used to assess the medication adherence level of patients. The scale is scored between 5 to 25 points with lower scores indicating higher adherence level.
2. Fragility Fracture Information Form [ Time Frame: through study completion; approximately 9 months ]
   The form will be used to assess the fragility fracture experience of participants. There are no cut-off values since this form will give the investigators descriptive information.
3. Health Behavior Assessment Form [ Time Frame: through study completion; approximately 9 months ]
   The form will be used to assess the smoking, diet or alcohol consumption of participants. There are no cut-off values since this form will give the investigators descriptive information.

Secondary Outcome Measures :

1. Brief Illness Perception Scale [ Time Frame: through study completion; approximately 9 months ]
   The scale will be used to assess participants' illness perception and cognition. To score the Brief Illness Perception Scale questionnaire, each item is rated on a 0-10 scale, with higher scores indicating a more threatening perception of the illness. The total score is calculated by summing the scores of all seven items, with a possible range of 0-70. Higher scores indicate worse illness perception.
2. The Beliefs About the Medicines Scale-Specific [ Time Frame: through study completion; approximately 9 months ]
   The scale will be used to assess the appraisal of the medicines. The Beliefs About the Medicines Scale-Specific consists of two five-item scales assessing participants' beliefs about the necessity of prescribed medication for controlling their disease and their concerns about potential adverse consequences of taking it. Respondents indicate their degree of agreement with each statement on a five-point Likert scale, ranging from 1=strongly disagree to 5=strongly agree. Scores obtained for individual items within both scales are summed. A mean score for each scale is computed by dividing total scores for that scale by the number of items in the scale, resulting in a mean score range of 1-5 for each scale. Higher scores indicate stronger beliefs in the concepts represented by the scale.
3. The Short Assessment of Patient Satisfaction [ Time Frame: through study completion; approximately 9 months ]
   The scale will be used to assess patient satisfaction comprised of a short seven-item scale that has 5-point responses, scored as 0 to 4. The scale assesses the core domains of patient satisfaction which includes treatment satisfaction, explanation of treatment results, clinician care, participation in medical decision-making, respect by the clinician, time with the clinician, and satisfaction with clinic care. The score ranges from 0 (extremely dissatisfied) to 28 (extremely satisfied), as a continuous score. Additionally, categorical scores are defined as 0-10 very dissatisfied, 11-18 dissatisfied, 19-26 satisfied, and 27-28 very satisfied.
4. Perceived Stress Scale [ Time Frame: through study completion; approximately 9 months ]
   The scale will be used to assess the stress perception of participants. The scores on the Perceived Stress Scale can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress; scores ranging from 14-26 would be considered moderate stress, and scores ranging from 27-40 would be considered high perceived stress.
5. Multidimensional Perceived Social Support Scale [ Time Frame: through study completion; approximately 9 months ]
   The scale will be used to assess the social support level of participants. The scale is a short instrument designed to measure an individual's perception of support from 3 sources: family, friends and a significant other. To calculate the total score, all 12 items are summed. This total score can also be calculated as a mean score (dividing by 12). A mean scale score ranging from 1 to 2.9 could be considered low support; a score of 3 to 5 could be considered moderate support; a score from 5.1 to 7 could be considered high support.
6. Brief Symptom Inventory- Depression and Anxiety [ Time Frame: through study completion; approximately 9 months ]
   The scale is a 13-item self-report scale designed to evaluate the depression and anxiety symptoms levels of participants. This scale uses a 5-point Likert scale, ranging from 0 ("not at all") to 4 ("extremely"). Brief Symptom Inventory- Depression and Anxiety scores can range from 0 to 52 points with higher scores indicating higher suffering from depression and anxiety symptoms.

Other Outcome Measures:

1. Sociodemographic and Clinical Information Form, [ Time Frame: through study completion; approximately 9 months ]
   The form will be used to get an illness history and demographical information. There are no cut-off values since this form will give the investigators descriptive information.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

Osteoporosis patients take for at 6 months.

Criteria

Inclusion Criteria:

• Diagnosis of primary or secondary osteoporosis or osteopenia with a previous fragility fracture
• Taking osteoporosis medicines for at least 6 months
• Volunteer to attend to study

Exclusion Criteria:

• Having been diagnosed with osteoporosis for less than six months
• Not willing to fulfil the requirements of the study
• Having a neurological (such as dementia) or psychological (such as psychosis) condition that prevents completing the scales and establishing a relationship with the tester.

Contacts and Locations

Contacts

Contact: Esin Temeloglu Sen, PhD; +905425726477; esin.sen@istanbul.edu.tr

Contact: Merih Akpinar, MD; 905333558843; merihcaliskan@gmail.com

Locations

Turkey

Istanbul University, Istanbul Faculty of Medicine

Istanbul, Turkey, 34

Contact: Merih Akpinar, MD 905333558843 merihcaliskan@gmail.com

Sponsors and Collaborators

Istanbul University

THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TÜRKİYE (TUBITAK)

More Information

Additional Information:

Medication adherence project final report 

Publications:

Clyne W, Mshelia C, McLachlan S, Jones P, de Geest S, Ruppar T, Siebens K, Dobbels F, Kardas P. A multinational cross-sectional survey of the management of patient medication adherence by European healthcare professionals. BMJ Open. 2016 Feb 1;6(2):e009610. doi: 10.1136/bmjopen-2015-009610.

Chandran M, Tan MZ, Cheen M, Tan SB, Leong M, Lau TC. Secondary prevention of osteoporotic fractures--an "OPTIMAL" model of care from Singapore. Osteoporos Int. 2013 Nov;24(11):2809-17. doi: 10.1007/s00198-013-2368-8. Epub 2013 Apr 25.

• Responsible Party: Esin Temeloglu Sen, Research Assistant Dr. (PhD), Istanbul University
• ClinicalTrials.gov Identifier: NCT05943600
• Other Study ID Numbers: OPKO-1
• First Posted: July 13, 2023
• Last Update Posted: July 13, 2023
• Last Verified: July 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: We will not share any individual participant data with other researchers.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Esin Temeloglu Sen, Istanbul University:

osteoporosis; fragile fracture risk; medication adherence; psychological symptom level; biopsychosocial model

Additional relevant MeSH terms:

Osteoporosis; Osteoporotic Fractures; Fractures, Bone; Wounds and Injuries; Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases