Study Design and Participants
A longitudinal follow-up study was employed to investigate the early health-related quality of life in individuals after surgical treatment for OVCFs. After approval from the Institutional Ethical Committee of Shanghai University of Medicine & Health Sciences (SUMHS) and the acquisition of informed consent, a total of 155 eligible individuals participated in the initial survey (T1). Subsequently, participants were invited to complete identical questionnaires at 1 month (T2) and 3 months (T3) following the baseline collection. One participant did not complete the questionnaire due to a serious health condition, and 4 participants were no longer interested in the study (T2, n = 150). In the subsequent investigation step, a total of 140 individuals completed the T3 questionnaire. Two participants were unable to continue due to health issues, and eight individuals dropped out at T3 because of lack of interest(Fig. 1). Reminder calls were made to make sure whether those participants had completely finished the follow-up questionnaires. All participants were recruited from Zhoupu Hospital affiliated with the SUMHS in China from 1 April 2023 to 30 September 2023. Questionnaires were distributed to patients on one day after OVCFs surgery (at baseline) (T1), and follow-up was subsequently conducted through outpatient examinations, telephone interviews, two-dimensional coded questionnaire surveys, and inpatient reexaminations at 1 month (T2) and 3 months after surgery (T3).
In this study, the inclusion criteria were as follows: (1) were over 50 years of age, had reading and writing abilities, and were able to communicate; (2) were diagnosed with OVCFs and confirmed to have undergone surgical treatment; (3) had complete cognitive and behavioral abilities; and (4) voluntarily participated in this study and signed a written informed consent. The exclusion criteria were: (1) patients with secondary vertebral fracture caused by infection, tumor, or other factors; (2) patients with vertebral fracture resulting from severe trauma (considering that osteoporosis has less impact); (3) patients with neurological defects associated with OVCFs; and (4) patients with a history of other diseases that clearly affect quality of life, such as malignant tumors or severe cardiopulmonary diseases.
Written informed consent regarding voluntary participation was obtained from all eligible patients before they completed the structured questionnaires.
Data sources and instruments
A total of 4 instruments were employed in the study. The first one collected demographic data and clinical information. The Osteoporosis Quality of Life scale (OQOLS) was used to examine life quality. The Social Support Rate Scale (SSRS) and Connor-Davidson Resilience Scale (CD-RISC) were used to investigate the profile of social support and mental resilience for OVCFs.
Demographic data and disease information
The demographic data included age, gender, educational level, marital status, income, employment status, knowledge about the operation, medical fee payment, and family-residence relationship. Apart from BMI and comorbidities, the disease information included (1) one or multiple vertebral fractures; (2) history of anti-osteoporosis medication; (3) history of fractures (including hip, spine, elbow, or wrist) before osteoporotic vertebral compression fracture; (4) chronic diseases (such as hypertension, diabetes, cerebrovascular accident, coronary heart disease, or COPD); and (5) preoperative fracture vertebra: thoracolumbar (T11-L2) or non-thoracolumbar level.
Social Support Scale (SSRS)
Social support was assessed using the Chinese version of the Social Support Scale (SSRS), which comprises three dimensions: utilization of support, subjective support, and objective support18. Total scale scores range from 12 to 66. Based on prior threshold scores, totals ≥ 49 indicate high social support, scores between 49 − 17 represent medium support, and totals ≤ 17 reflect low support. Cronbach's α was 0.708.
Connor-Davidson Resilience Scale (CD-RISC)
The scale, compiled by Connor and Davidson, consists of 25 items with three dimensions: tenacity (14 items), strength (7 items), and optimism (4 items). The study utilized a 5-point scoring system, presenting a total score range of 0 to 100. A higher score indicates a greater degree of mental resilience. A score of less than 56 points indicates a low resilience level; 57 ~ 70 points suggests a medium resilience level, while 71–100 points shows a high resilience level. In the present study, the CD-RISC demonstrated excellent internal consistency (Cronbach' s α = 0.91) 19.
Osteoporosis Quality of Life Scale (OQOLS)
This questionnaire evaluates the variety of dimensions of health-related quality of life in individuals with primary osteoporosis. This 75-item questionnaire utilizes a 5-point Likert scale ranging from 1 (None at all) to 5 (Very serious). The questionnaire comprises five function scales (disease dimension, physiological dimension, psychological dimension, social dimension, and satisfaction dimension). A positive correlation exists between higher OQOLS scores and improved HRQoL. The OQOLS integrating a suitable general scale with a scale specific to the disease demonstrates the sensitivity to variations of the patients' health status. The OQOLS presents excellent overall internal reliability (Cronbach' s α = 0.981) and good sub-scale reliability (0.873–0.967). Factor analysis supports the structural validity of the OQOLS20.
Statistical analyses
The demographic data and clinical characteristics are presented as the means and standard deviations for continuous variables, and as frequency counts (percentages) for categorical variables. Repeated measures analysis of variance examined changes in HRQoL, mental resilience, and social support across time points(Fig. 3). Analysis of variance (ANOVA) also explored associations between demographic and disease factors and HRQoL. Variables significantly related to HRQoL in univariate analyses, including demographics, disease characteristics, mental resilience, and social support, were entered into a multiple linear regression model to identify predictors of HRQoL. Missing data were replaced by series means.
A cross-lagged model was evaluated through structural equation modeling (SEM) using AMOS v24 maximum likelihood estimation. Model fit was assessed via: chi-square/degrees of freedom ratio, standardized root mean square residual (SRMR), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and comparative fit index (CFI)21 22. According to the recommendation of the acceptable model index, adequate fit is indicated by TLI and CFI > 0.95, SRMR and RMSEA < 0.05, and χ2/df ratio < 5.0.
Mediation effects tested using the PROCESS macro for SPSS with 5000 bootstrap resamples to estimate indirect effects and 95% bias-corrected confidence intervals. Statistical significance was defined as P < 0.05. Analyses were conducted in SPSS v26.0 (IBM Corp, Armonk, NY)..