Acceptability of self-completion versus face-to-face use of a vertebral fragility fracture clinical decision tool for use in older people with back pain in the UK

Summary:
This study tested the agreement between self-completion and face-to-face completion of a vertebral fracture clinical decision tool called Vfrac in order to make an evidence-based recommendation of how Vfrac should be used for future research or clinical applications. Findings confirmed that it is necessary to take the physical measurements face-to-face.

Background:
Around 12% of older adults have vertebral fragility fractures but fewer than one-third are diagnosed. Vfrac is a vertebral fracture screening tool developed to help clinicians identify which patients are at a high risk of having a vertebral fracture, so they can be referred for a spinal radiograph. The aim of this work was to assess the agreement between self-completion and face-to-face use of Vfrac and determine patient preference for use.

Methods:
Adults aged > 65 years who had experienced back pain in the last 4 months were invited to self-complete Vfrac and have Vfrac completed face-to-face with a healthcare professional. Agreement between low risk or high risk Vfrac scores from self-completion and face-to-face assessment was represented by Cohen’s kappa; agreement in scores was also assessed between fully face-to-face and hybrid completion of Vfrac where only physical measurements are taken face-to-face and the rest self-completed. Data on satisfaction, ease of use and preference for use was also collected.

Results:
Data from 76 participants including 58 men and 18 women who both self-completed Vfrac and had Vfrac completed face-to-face was used to compare agreement in Vfrac scores. The mean age of participants was 76.4 years (range 65–92). There was moderate agreement in Vfrac scores (kappa 0.53; 95% confidence interval 0.31–0.75) between self-completed and face-to-face completed Vfrac with varied scores for 11 participants out of 76 (14.5%).There was only slight agreement (kappa < 0.2) for each of the three physical measurements between self-completed and face-to-face completed Vfrac. A moderate level of agreement (kappa 0.51) was also observed between fully face-to-face and hybrid completion of Vfrac. Thirty-seven percent of participants had no strong preference for how Vfrac should be completed, 33% preferred self-completion, and 30% preferred face-to-face completion.

Conclusions:
This study has resulted in the recommendation that future use of this tool should include completion of the physical measurements by a healthcare professional face-to-face, combined with the option of patients either self-completing the questions at home before their appointment or face-to-face at the time of the physical measurements, depending on individual preference.

Trial registration:
ISRCTN12150779.