Telerehabilitation Versus Traditional Balance Training in Women With Osteoporosis.

Comparison of Telerehabilitation and Traditional Balance Training in Post Menopausal Women With Osteoporosis.

Osteoporosis is a silent disease that leads to fractures, postural deformities, and impaired balance, especially in postmenopausal women. In Pakistan, prevalence is high, with 39% of women reported as severely osteoporotic. Postmenopausal women with osteoporosis and balance issues face increased fall risk due to poor bone density, weakened muscles especially in the lower limb band altered posture .Balance and strength training reduce fall risk, but access to in-person rehabilitation is limited. Telerehabilitation provides remote delivery of structured exercise programs and has shown positive outcomes in balance and bone health. Few studies, however, have compared telerehabilitation with conventional training across all balance domains. The goal of this randomized controlled trial is to compare the effect of Telerehabilitation and Traditional Balance Training in Post Menopausal Women with osteoporosis. Participants will be randomly assigned to one of the two groups, and both will receive an identical standardized balance training program . The results of this clinical trial will help evaluate how telerehabilitation can improve the balance of postmenopausal women with osteoporosis and improve health outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Osteoporosis Postmenopausal
• Intervention / Treatment: Other: Telerehabilitation group; Other: Traditional balance training group

Detailed Description

Osteoporosis often remains undetected until fractures occur, typically involving the hip, wrist, or spine, and may also cause back pain, height loss, and kyphosis. Postmenopausal women face increased fall risk due to reduced bone density, weakened lower limb muscles, and altered posture. Many also develop fear of falling, which restricts activity and accelerates muscle weakness.

Globally, osteoporosis affects about 23.1% of women and 11.7% of men, with fragility fractures being a major cause of disability. In Pakistan, hospital-based findings show a high proportion of postmenopausal women as severely osteoporotic, with a strong link to fall-related injuries.

Exercise interventions, including balance, resistance, and weight-bearing training, are known to improve bone strength, postural control, and confidence by stimulating bone remodelling and enhancing musculoskeletal performance. Telerehabilitation, delivered via video conferencing, provides remote access to such programs and has demonstrated improvements in stability, weight-shifting, and functional balance.

However, most studies assess limited outcomes using tools like TUG or BBS, without addressing static, dynamic, anticipatory, and reactive balance together. Evidence largely comes from high-income countries, while data from resource-limited settings like Pakistan remain scarce. This trial seeks to evaluate telerehabilitation compared to traditional training across comprehensive balance domains in postmenopausal women with osteoporosis.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Prof. Dr. Huma Riaz; Phone Number: +92 3215242874; Email: huma.riaz@riphah.edu.pk

Study Locations

• Pakistan
  • ICT
    • Islamabad, ICT, Pakistan
      • Riphah International Hospital
      • Contact: Dr. Ammara Malik; Phone Number: +92 3145326065; Email: ammara.malik@riphah.edu.pk
      • Principal Investigator: Mehak Bibi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• • Women diagnosed with osteopenia and osteoporosis at hip and lumbar spine through DEXA

  • Age 50-70 years
  • Have mobile phones and can communicate in video call
  • Have Balance score (21-44) on berg balance scale
  • A caregiver must be available to assist the participant during Tele sessions.

Exclusion Criteria:

• • Women with severe mobility impairments.

  • Women with cognitive conditions affecting participation.
  • Women with lower limb joint injury or surgery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Telerehabilitation group; This group will receive a 6 week structured telerehabilitation exercise protocol of low to moderate intensity (18 sessions , 3 sessions per week,45 to 60 minutes ), warmup, balance training and cool down exercises. delivered online by a physiotherapist and progressively increasing every three weeks.	Other: Telerehabilitation group; The telerehabilitation group participated in balance training sessions delivered through secure virtual platforms such as WhatsApp video calls. Participants completed 3 sessions per week, each lasting 45-60 minutes, over a total of 6 weeks (18 sessions). The program target static, dynamic, anticipatory, and reactive balance. participants will use households items.session began with warm-up exercises such as gentle marching, arm circles, and hamstring stretches, followed by balance training targeting static, dynamic, anticipatory, and reactive components. Exercises included heel-to-toe standing, single-leg stance, tandem stance, obstacle walking, heel-to-toe walking, side stepping, functional reach, weight shifting, caregiver-assisted perturbations, and foam surface standing. All exercises were performed in 3 sets with specified holds or repetitions. Sessions concluded with cool-down activities including tricep stretches, forward bends, and deep breathing.
Active Comparator: Traditional Balance Training group; In the traditional balance training group the protocol will be delivered by a physiotherapist in a clinical environment face to face. The standardized balance training protocol will be monitored exactly the same as telerehabilitation group	Other: Traditional balance training group; Same as telerehabilitation group but it will concluded in a clinical setting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Berg Balance Scale score	The Berg Balance Scale (BBS) is a widely used clinical tool to assess static and dynamic balance in individuals, particularly older adults. It's a 14-item test that evaluates a person's ability to perform various balance-related tasks, such as sitting, standing, reaching, and turning. Each item is scored on a 0-4 scale, with 0 indicating the lowest level of function and 4 indicating the highest. The total score ranges from 0 to 56, with lower scores suggesting a higher risk of falls	Baseline and 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Time up and Go test score	The Timed Up and Go Test (TUG) is a simple yet widely validated tool used to assess mobility and fall risk. It measures how quickly an individual can rise from a chair, walk three meters, turn, walk back, and sit down	Baseline and 6 weeks
Functional reach test	The Functional Reach Test (FRT) assesses how far an individual can reach forward while standing, without stepping or losing balance. It's particularly effective for identifying balance limitations in frail or elderly populations	Baseline and 6 weeks
Change in Push and release test score	Push and Release Test is designed to measure reactive postural control by observing how a person recovers after being released from a supported backward lean.	Baseline and 6 weeks
Change in Single leg stance test score	The Single Leg Stance Test (SLS) is a simple but powerful tool to evaluate balance and stability, particularly in older adults or individuals with conditions like osteoporosis. In this test, the person is asked to stand on one leg usually with eyes open and hands on hips while the clinician times how long they can maintain that position without support. It's an effective way to spot balance problems that could lead to falls	Baseline and 6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Prof. Dr. Huma Riaz, Riphah International University

Publications and helpful links

General Publications

• Li S, Li Y, Liang Q, Yang WJ, Zi R, Wu X, Du C, Jiang Y. Effects of tele-exercise rehabilitation intervention on women at high risk of osteoporotic fractures: study protocol for a randomised controlled trial. BMJ Open. 2022 Nov 7;12(11):e064328. doi: 10.1136/bmjopen-2022-064328.
• Rezaei MK, Torkaman G, Bahrami F, Bayat N. The effect of six week virtual reality training on the improvement of functional balance in women with type-I osteoporosis: A preliminary study. Sport Sci Health. 2023;19(1):185-194. doi: 10.1007/s11332-022-01018-8. Epub 2022 Nov 15.
• Wei F, Hu Z, He R, Wang Y. Effects of balance training on balance and fall efficacy in patients with Osteoporosis: A systematic review and meta-analysis with trial sequential analysis. J Rehabil Med. 2023 May 17;55:jrm00390. doi: 10.2340/jrm.v55.4529.

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: August 24, 2025
• First Submitted That Met QC Criteria: August 24, 2025
• First Posted (Estimated): August 29, 2025

Study Record Updates

• Last Update Posted (Actual): December 1, 2025
• Last Update Submitted That Met QC Criteria: November 28, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Balance; Telerehabilitation; Osteoporosis; Virtual exercise; Posmenopausal
• Additional Relevant MeSH Terms: Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases; Bone Diseases, Metabolic; Nutritional and Metabolic Diseases; Osteoporosis; Osteoporosis, Postmenopausal
• Other Study ID Numbers: Mehak bibi

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No