Effect of an Integrated Education and Exercise Program on Osteoporosis Knowledge in a Medical Rehabilitation Setting: A One-Group Pre-Posttest Study
DOI:
https://doi.org/10.53713/htechj.v4i5.617Keywords:
Education, Outreach, Osteoporosis PreventionAbstract
Osteoporosis remains an important public health concern because inadequate awareness of its risk factors and preventive strategies may delay the adoption of protective health behaviors. Educational interventions combined with practical exercises may strengthen knowledge about osteoporosis and support preventive awareness. This study evaluated changes in osteoporosis-related knowledge following a structured education and preventive exercise program delivered in a medical rehabilitation setting. A quantitative one-group pre-test–post-test design was conducted with 20 patients and their accompanying individuals at the Medical Rehabilitation Unit of R.T. Notopuro Regional General Hospital, Sidoarjo, Indonesia. Participants were recruited using purposive sampling. Osteoporosis-related knowledge was assessed using a structured seven-item questionnaire administered before and immediately after the intervention. The program included education on osteoporosis, its risk factors, preventive measures, and low-impact exercises to target muscle strength, balance, and flexibility. Descriptive statistics and a paired-samples t-test were used for analysis. The mean proportion of correct responses increased from 38.33% on the pre-test to 80.83% on the post-test. Participant-level analysis showed a mean increase in score of 2.55 points (SD = 1.47; SE = 0.33; 95% CI: 1.86–3.24), with a statistically significant difference between assessments (t(19) = 7.77, p < 0.001). The integrated osteoporosis education and exercise program was associated with a substantial short-term improvement in participants' knowledge of osteoporosis. Further controlled studies with larger sample sizes and longer follow-up periods are required to assess knowledge retention and behavioral outcomes.
Downloads
References
Ahmed, S., Farooqui, A. J., Pradhan, N. A., Zehra, N., Majid, H., Jafri, L., & Khan, A. H. (2023). Assessing the knowledge, attitude, and practice of osteoporosis among Pakistani women: A national social-media-based survey. PLOS ONE, 18(11), e0288057. https://doi.org/10.1371/journal.pone.0288057
Alhouri, A., Zahrawi, H., Alasaad, S., Alhayek, S. M., Al Houri, H. N., Jomaa, S., Torbey, A., Swed, S., Alamash, D., Zawda, A., Alhasan, S. A., Khalayli, N., & Kudsi, M. (2022). Assessing the knowledge and attitude towards osteoporosis among Syrian women: A cross-sectional study. International Journal of Rheumatology, 2022, 6431151. https://doi.org/10.1155/2022/6431151
Anupama, D. S., Noronha, J. A., Acharya, K. K. V., Prabhu, M., Ravishankar, N., & Nayak, B. S. (2023). Effect of lifestyle modification intervention program on bone mineral density among postmenopausal women with osteoporosis. Sultan Qaboos University Medical Journal, 23(3), 387–393. https://doi.org/10.18295/squmj.1.2023.010
Askarian, M., Baloochi, A., Vizeshfar, F., Mohammadizadeh, F., Mottahedi, M., & Abaszadeh, F. (2026). Development and psychometric evaluation of the Osteoporosis Preventing Behaviors Questionnaire (OPBQ) based on Pender’s health promotion model. BMC Public Health, 26, 21. https://doi.org/10.1186/s12889-025-25697-3
Bae, S., Lee, S., Park, H., Ju, Y., Min, S.-K., Cho, J., Kim, H., Ha, Y.-C., Rhee, Y., Kim, Y.-P., & Kim, C. (2023). Position statement: Exercise guidelines for osteoporosis management and fall prevention in osteoporosis patients. Journal of Bone Metabolism, 30(2), 149–165. https://doi.org/10.11005/jbm.2023.30.2.149
Bierer, S. B., Beck Dallaghan, G., Borges, N. J., Brondfield, S., Fung, C. C., Huggett, K. N., Teal, C. R., Thammasitboon, S., & Colbert, C. Y. (2025). Moving beyond simplistic research design in health professions education: What a one-group pretest-posttest design will not prove. MedEdPORTAL, 21, 11527. https://doi.org/10.15766/mep_2374-8265.11527
Chan, C. Y., Subramaniam, S., Chin, K.-Y., Ima-Nirwana, S., Muhammad, N., Fairus, A., Ng, P. Y., Aini, J. N., Aziz, N. A., & Mohamed, N. (2022). Effect of a screening and education programme on knowledge, beliefs, and practices regarding osteoporosis among Malaysians. International Journal of Environmental Research and Public Health, 19(10), 6072. https://doi.org/10.3390/ijerph19106072
Chellamuthu, L., Mary, J. J. F., & Palanichamy, S. (2025). Osteoporosis Knowledge Assessment Tool–Tamil (OKAT-T) in postmenopausal women: A validity and reliability study. Journal of Clinical Orthopaedics and Trauma, 60, 102845. https://doi.org/10.1016/j.jcot.2024.102845
Darawad, M. W., Shawashi, T. O., Al Duraidi, H., & Nofal, B. (2022). Osteoporosis education: Evaluation of an awareness program among female university students. International Journal of Orthopaedic and Trauma Nursing, 45, 100926. https://doi.org/10.1016/j.ijotn.2022.100926
Ding, H., Li, H.-X., Ai, Y.-W., Zhang, Q.-Y., Tang, H.-T., & Zeng, W. (2025). Assessment of understanding, attitudes, and clinical practices regarding osteoporosis among postgraduate students in China. BMC Medical Education, 25, 1197. https://doi.org/10.1186/s12909-025-07785-5
Elgzar, W. T., Nahari, M. H., Sayed, S. H., & Ibrahim, H. A. (2023). Determinant of osteoporosis preventive behaviors among perimenopausal women: A cross-sectional study to explore the role of knowledge and health beliefs. Nutrients, 15(13), 3052. https://doi.org/10.3390/nu15133052
Hauser, A.-L., Noriega Urena, J.-F., Saatashvili, L., Esmail, F., Lange, T., Schulte, T. L., & von Glinski, A. (2026). Effect of a one time guideline based educational video intervention on osteoporosis related knowledge. Archives of Orthopaedic and Trauma Surgery, 146, 143. https://doi.org/10.1007/s00402-026-06293-5
Hoffmann, I., Shojaa, M., Kohl, M., von Stengel, S., Becker, C., Gosch, M., Jakob, F., Kerschan-Schindl, K., Kladny, B., Clausen, J., Lange, U., Middeldorf, S., Peters, S., Schoene, D., Sieber, C., Tholen, R., Thomasius, F., Bischoff-Ferrari, H. A., Uder, M., & Kemmler, W. (2022). Exercise reduces the number of overall and major osteoporotic fractures in adults. Does supervision make a difference? Systematic review and meta-analysis. Journal of Bone and Mineral Research, 37(11), 2132–2148. https://doi.org/10.1002/jbmr.4683
Hsu, H.-H., Chiu, C.-Y., Chen, W.-C., Yang, Y.-R., & Wang, R.-Y. (2024). Effects of exercise on bone density and physical performance in postmenopausal women: A systematic review and meta-analysis. PM&R, 16(12), 1358–1383. https://doi.org/10.1002/pmrj.13206
Ierulli, V. K., Hartman, H., Rumps, M. V., & Mulcahey, M. K. (2025). Physician-led education and handouts are most effective for educating patients about osteoporosis. Patient Education and Counseling, 138, 109186. https://doi.org/10.1016/j.pec.2025.109186
Jamil, N. A., Dhanaseelan, J., & Buhari, N. A. (2024). Effectiveness of an e-book on bone health as educational material for adolescents: Single-group experimental study. JMIR Pediatrics and Parenting, 7, e56611. https://doi.org/10.2196/56611
Jeihooni, A. K., Rakhshani, T., Khiyali, Z., Ebrahimi, M. M., & Afzali Harsini, P. (2022). The effect of educational intervention based on theory of planned behavior on behavioral responses of premenopausal women in prevention of osteoporosis. BMC Women’s Health, 22, 366. https://doi.org/10.1186/s12905-022-01953-1
Moayyeri, A., Warden, J., Han, S., Suh, H. S., Pinedo-Villanueva, R., Harvey, N. C., Curtis, J. R., Silverman, S., Multani, J. K., & Yeh, E. J. (2023). Estimating the economic burden of osteoporotic fractures in a multinational study: A real-world data perspective. Osteoporosis International, 34, 2121–2132. https://doi.org/10.1007/s00198-023-06895-4
Mouchaers, I., Metzelthin, S., van Haastregt, J., Vlaeyen, E., Goderis, G., & Verbeek, H. (2023). Exploring the support and involvement of family caregivers for reablement programs: A qualitative study. Journal of Multidisciplinary Healthcare, 16, 2993–3005. https://doi.org/10.2147/JMDH.S424147
Newman, M., Room, J., Hannink, E., & Barker, K. L. (2025). Development and implementation of a physiotherapy exercise intervention with tailored support for exercise adherence for people with vertebral fragility fractures (OPTIN trial). Physiotherapy, 126, 101430. https://doi.org/10.1016/j.physio.2024.101430
Peksoy-Kaya, S., Kaplan, S., & Başkaya, E. (2024). A survey of the effect of an information-motivation-behavioral model-based intervention on university students’ osteoporosis knowledge, health beliefs, and self-efficacy. Women & Health, 64(10), 870–883. https://doi.org/10.1080/03630242.2024.2422884
Rizzoli, R., & Chevalley, T. (2024). Nutrition and osteoporosis prevention. Current Osteoporosis Reports, 22(6), 515–522. https://doi.org/10.1007/s11914-024-00892-0
Şahin, M. A., Aydemir, M. D., Çolakoğlu, B. D., Çakmur, R., Ünal, B., & Gülbahar, S. (2024). The effect of osteoporosis education on osteoporosis knowledge level and daily life in Parkinson’s disease patients: A 12-week, randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 70(3), 379–389. https://doi.org/10.5606/tftrd.2024.13026
Singer, A. J., Sharma, A., Deignan, C., & Borgermans, L. (2023). Closing the gap in osteoporosis management: The critical role of primary care in bone health. Current Medical Research and Opinion, 39(3), 387–398. https://doi.org/10.1080/03007995.2022.2141483
Taghvaei, R., Dimitrova, D., Karaman, M., & Sehouli, J. (2022). Knowledge and understanding risk factors and preventive measures for osteoporosis in women: Results of a survey in 502 women with and without a migration background. BMC Musculoskeletal Disorders, 23, 824. https://doi.org/10.1186/s12891-022-05773-0
Tsai, C.-C., Chen, P.-Y., Tsai, M.-Y., Wu, C.-S., & Chen, M.-F. (2024). The effect of a bone-preserving board game program on the knowledge, attitudes and preventive behaviors of osteoporosis in older adults. Geriatric Nursing, 56, 212–217. https://doi.org/10.1016/j.gerinurse.2024.02.007
Wang, L., Li, Y., Gu, J., Xiao, L., & Wang, J. (2024). Knowledge, awareness and perception towards osteoporosis risk in China: A systematic review. Iranian Journal of Public Health, 53(5), 1009–1020. https://doi.org/10.18502/ijph.v53i5.15581
Wang, M., & Seibel, M. J. (2023). Approach to the patient with bone fracture: Making the first fracture the last. The Journal of Clinical Endocrinology & Metabolism, 108(12), 3345–3352. https://doi.org/10.1210/clinem/dgad345
Xiong, F., Zang, A., Xu, Z., Cao, Q., Shen, Z., Qian, F., & Xu, H. (2025). Knowledge, attitude, and practice towards postmenopausal osteoporosis among postmenopausal women: A cross-sectional study. Preventive Medicine Reports, 58, 103234. https://doi.org/10.1016/j.pmedr.2025.103234
Xue, M., Xia, J., You, X., Zhu, X., Zheng, L., Wei, Q., Zheng, M., Tao, J., Shen, Y., Zhou, Q., Qian, J., Chu, M., & Xu, Y. (2025). Knowledge, attitudes, and practices toward osteoporosis: A questionnaire survey. Frontiers in Public Health, 13, 1621402. https://doi.org/10.3389/fpubh.2025.1621402
Zhang, Y.-Y., Zhang, Y.-G., Li, Z., Li, S.-H., & Xu, W.-G. (2022). Effect of home-based telerehabilitation on the postoperative rehabilitation outcome of hip fracture in the aging population. Orthopaedic Surgery, 14(8), 1768–1777. https://doi.org/10.1111/os.13293
Ziebart, C., MacDermid, J., Bryant, D., & Szekeres, M. (2025). Development of an online exercise and education program for adults post-distal radius fracture. Journal of Hand Therapy, 38(2), 226–234. https://doi.org/10.1016/j.jht.2025.04.017
Ziyar, A., Bolufer, A., Littman, E., & Beg, S. (2025). An examination of patient knowledge and education in patients with osteoporosis, osteopenia, and normal bone density. Journal of Clinical Densitometry, 28(3), 101578. https://doi.org/10.1016/j.jocd.2025.101578
