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Shannon ZK, Long CR, Chrischilles EA, Goertz CM, Wallace RB, Casteel C, Carnahan RM. Effect of chiropractic care on low back pain for active-duty military members: Mediation through biopsychosocial factors. PLoS One 2024; 19:e0310642. [PMID: 39352877 PMCID: PMC11444394 DOI: 10.1371/journal.pone.0310642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. Mediation of the adjusted mean effect difference on 12-week outcomes of PROMIS-29 pain interference and intensity by 6-week mediators of other PROMIS-29 physical, mental, and social health subdomains was evaluated. The effect difference on pain interference occurring through PROMIS-29 biopsychosocial factors (natural indirect effect = -1.59, 95% CI = -2.28 to -0.88) was 56% (95% CI = 35 to 96) of the total effect (-2.82, 95% CI = -3.98 to -1.53). The difference in effect on pain intensity occurring through biopsychosocial factors was smaller (natural indirect effect = -0.32, 95% CI = -0.50 to -0.18), equaling 26% (95% CI = 15 to 42) of the total effect (-1.23, 95% CI = -1.52 to -0.88). When considered individually, all physical, mental, and social health factors appeared to mediate the effect difference on pain interference and pain intensity with mental health factors having smaller effect estimates. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.
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Affiliation(s)
- Zacariah K. Shannon
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States of America
| | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States of America
| | - Elizabeth A. Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Christine M. Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Robert B. Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Carri Casteel
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Ryan M. Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
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Sell TC, Zerega R. Reliability of a Musculoskeletal Assessment for the Examination of Cervical Spine Pain and Injuries in Special Forces Combat Soldiers. Sports (Basel) 2024; 12:255. [PMID: 39330732 PMCID: PMC11435987 DOI: 10.3390/sports12090255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/28/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
An assessment of protocol reliability is an essential step prior to human subject testing for injury prevention. The purpose of this study was to examine the inter-rater and intra-rater reliability of a portable cervical range of motion and isometric strength protocol designed for special forces combat soldiers who are at risk for cervical spine pain and injury due to exposure to head-supported mass. Eight individuals were tested three times to assess reliability, the standard error of the measurement (SEM), and the minimal detectable change across six range of motion measures and six strength measures of the cervical spine. One tester tested all participants twice for intra-rater reliability, and a second tester assessed the participants to examine inter-tester reliability. All reliability measures demonstrated good to excellent reliability (ICC = 0.70-0.96 (isometric strength); ICC = 0.85-0.94 (range of motion)). All SEM scores were 12% or lower for all reliability measures. The findings of this study demonstrate that the protocol developed for a longitudinal multi-site study is reliable and appropriate to implement for injury prevention in military personnel.
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Affiliation(s)
- Timothy C. Sell
- Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA;
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Lang RW, Porensky P, Fraser JJ. Burden and Risk Factors of Cervical Spine Conditions in Military Aircrew From 1997 to 2015: A Retrospective Cohort Study. Mil Med 2024:usae423. [PMID: 39255238 DOI: 10.1093/milmed/usae423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/03/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024] Open
Abstract
INTRODUCTION Military aviators may have increased risk of cervical spine injuries because of exposure to supraphysiologic forces and vibration during dynamic flight. Aviator medical attrition impairs mission readiness, decreases operational capabilities, increases overall DoDcosts, and decreases retention of seasoned aviators. This study evaluated incidence and risk factors for cervical spine conditions in U.S. military aviators from 1997 to 2015. MATERIALS AND METHODS The Defense Medical Epidemiological Database was queried for aviators with a diagnosis of cervical spine conditions. Pertinent ICD-9 codes for cervical spine pathology were ascertained from U.S. Army, Air Force, and Naval Air Forces aeromedical references. Negative binomial regressions assessed sex, age, service, aircraft, and year on incidence of conditions. Rates were compared to non-aviator controls. The study was approved by the Institutional Review Board at the Naval Health Research Center (NHRC.2020.0205-NHSR). RESULTS Incidence rates were 9.78 to 12.57/1,000 person-years for neck pain, 2.04 to 3.89/1,000 person-years for degenerative conditions without neurological involvement, and 0.94 to 1.36/1,000 person-years for degenerative conditions with neurological involvement. Aviation occupation (relative risk [RR] 1.41-2.05), female sex (RR 3.32-7.89), age over 40 (RR 2.39-4.62), and service in the Army or Marine Corps (RR 1.62-2.14) were risk factors. CONCLUSIONS Military aviators had a statistically significant increase in risk of neck pain and medically disqualifying degenerative cervical spine conditions compared to non-aviator controls. Rates of neck pain increased in all aviators over the study epoch. Possible explanations could be related to the operational demands and the increased use of forward helmet-mounted display systems during the study period, a supposition that requires further investigation. There was no significant difference in rates of neck pain or degenerative cervical conditions between aircraft platforms (fighter/bomber, other fixed wing, and rotary wing). Female sex, age over 40 years, and Army/Marine Corps service were the greatest risk factors for neck pain and degenerative cervical spine conditions. Targeted prevention programs and expanded treatment modalities are necessary to reduce aviator attrition and Department of Defense cost burden.
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Affiliation(s)
- Richard W Lang
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Paul Porensky
- Department of Neurological Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - John J Fraser
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA 92106-3521, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40536-0200, USA
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Brink KJ, McKenzie KL, Straight CR, O'Fallon KS, Kim SK, Likens AD. Altered movement dynamics in soldiers undergoing multiple bouts of load carriage. APPLIED ERGONOMICS 2024; 119:104315. [PMID: 38754256 DOI: 10.1016/j.apergo.2024.104315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/26/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Kolby J Brink
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
| | - Kari L McKenzie
- US Army Combat Capabilities Development Command Soldier Center, Natick, MA, USA
| | - Chad R Straight
- US Army Combat Capabilities Development Command Soldier Center, Natick, MA, USA
| | - Kevin S O'Fallon
- US Army Combat Capabilities Development Command Soldier Center, Natick, MA, USA
| | - Seung Kyeom Kim
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Aaron D Likens
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
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Wang P, Zhou S, Li B, Wang Y, Xu W. Investigating Research Hotspots of Combat-related Spinal Injuries: A 30-year Bibliometric Analysis Study. Mil Med 2024; 189:e1982-e1988. [PMID: 38771111 PMCID: PMC11363387 DOI: 10.1093/milmed/usae178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/15/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Spinal cord injuries often lead to significant motor and sensory deficits, as well as autonomic dysfunction. Compared with normal spinal injuries, combat-related spinal injuries (CRSIs) are usually more complex and challenging to treat because of multiple traumas, firing-line treatments, and arduous initial treatments on a battlefield. Yet numerous issues remain unresolved about clinical treatment and scientific research. The enhancement of CRSI diagnosis and treatment quality by military surgeons and nurses is imperative. The objective of this study is to identify the frontiers, hotspots, and trends among recent research, summarize the development process of clinical trials, and visualize them systematically. MATERIALS AND METHODS We collected publications from CRSI based on the Core Collection of Web of Science for 30 years from January 1, 1993 to May 1, 2023.Visualizations of the knowledge maps were produced using VOSviewer and CiteSpace software. We examined annual trends of publications and distribution patterns, the number of publications, as well as the research hotspots. RESULTS Among 201 documents, it was found that there was a stable upward trend in publications. There were 2 rapid growth stages during the 30 years. Among all countries, the USA contributed the most publications, along with the highest influence and the most international cooperation. Military Medicine was the journal of the maximum publications, whereas the Spine journal was the most influential one. Keyword co-occurrence analysis and trend topics analysis revealed that these articles focused 5 distinct categories for CRSI. CONCLUSIONS As the first bibliometric study focused on CRSI, we demonstrated the evolution of the field and provided future research directions. We summarized the hotspots and 5 clusters published. This would serve as a useful guide for clinicians and scientists regarding CRSI global impacts.
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Affiliation(s)
- Pengru Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Shangbin Zhou
- Department of Orthopedic Oncology, Naval Medical Center, Naval Military Medical University, Shanghai 200030, China
| | - Bo Li
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Yingtian Wang
- Medical Administration Division, Chinese PLA General Hospital, Beijing 100141, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
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Choi H, Purushothaman Y, Ozobu I, Yoganandan N. Is Posterior Cervical Foraminotomy Better Than Fusion for Warfighters?: A Biomechanical Study. Mil Med 2024; 189:710-718. [PMID: 39160815 DOI: 10.1093/milmed/usae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/26/2024] [Accepted: 04/25/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Cervical spondylosis in the warfighter is a common musculoskeletal problem and can be career-ending especially if it requires fusion. Head-mounted equipment and increased biomechanical forces on the cervical spine have resulted in accelerated cervical spine degeneration. Current surgical gold standard is anterior cervical discectomy and fusion (ACDF). Posterior cervical foraminotomy (PCF) is a nonfusion surgical alternative, and this can be effective in alleviating radiculopathy from foraminal stenosis caused by disc-osteophyte complex. Biomechanical studies have not been done to analyze motion associated with military aircrew personnel following PCF. The aim of this study was to compare the biomechanical responses of the effects of ACDF and PCF with different grades of facet resection under simulated military aircrew conditions using range of motion, disc pressure, and facet loads at the index and adjacent levels. MATERIALS AND METHODS A validated 3D finite element model of the human cervical spinal column was used to simulate various graded PCF and ACDF. All surgical simulations were performed at the most commonly operated level (C5-C6) in warfighters. Pure moment loading under flexion, extension, and lateral bending, and in vivo follower force of 75 N were applied to the intact spine. Hybrid loading protocol was used to achieve 134 degrees of combined flexion-extension and 83 degrees of lateral bending in intact and surgical models to reflect military loading conditions. Segmental motions, disc pressure, and facet load were obtained and normalized with respect to the intact model to quantify the biomechanical effect. RESULTS Anterior cervical discectomy and fusion decreased range of motion at the index and increased motion at the adjacent levels, while all graded PCF responses had an opposite trend: increased motion at the index and decreased motion at adjacent levels. The magnitude of changes depended on the level of resection, spinal level, and loading mode. Disc pressure increased at the index level and decreased at the adjacent levels after PCF. These changes were exaggerated with increasing extent of facet resection. Facet load increased at the index level after PCF especially with extension and right (contralateral) lateral bending. Complete facetectomy led to facet load increases greater than ACDF at the adjacent levels in both flexion and extension. CONCLUSIONS Posterior cervical foraminotomy is a motion-preserving implant-free surgical alternative to ACDF for warfighters with cervical radiculopathy after failure of conservative management. The treating surgeon must pay close attention to the extent of facet resection to avoid potential spinal instability and future disc and facet degeneration after PCF. Posterior cervical foraminotomy can be more advantageous than ACDF in terms of adjacent segment degeneration, motion preservation, reoperation rate, surgical cost, and retention of warfighters.
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Affiliation(s)
- Hoon Choi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Yuvaraj Purushothaman
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Ifeanyichukwu Ozobu
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
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Homeier DD, Kang D, Molinari R, Mesfin A. The top-cited military relevant spine articles. J Orthop 2024; 54:38-45. [PMID: 38524362 PMCID: PMC10957343 DOI: 10.1016/j.jor.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Historically musculoskeletal injury has substantially affected United States (US) service members. Lumbosacral spine injuries are among the most common sites of injury for service members across all US military branches and usually presents with pain in the lower back and extremities. The aim of this study is to identify and describe the 50 most-cited articles relevant to military medicine on the subject of the spine. Methods In April 2020 Web of Science was used to search the key words: spinal cord injury, spine, thoracic spine, lumbar spine, cervical spine, sacrum, sacral, cervical fusion, lumbar fusion, sacral fracture, combat, back pain, neck pain, and military. Articles published from 1900 to 2020 were evaluated for relevance to military spine orthopaedics and ranked based on citation number. The 50 most-cited articles were characterized based on country of origin, journal of publication, affiliated institution, topic, military branch, and conflict. Results 1900 articles met search criteria. The 50 most-cited articles were cited 24 to 119 times and published between 1993 and 2017. 30 articles (60%) originated in the United States. Aviation, Space, and Environmental Medicine accounted for the most frequent (n = 10) destination journal followed by Spine (n = 8). 37 institutions contributed to the top 50 most-cited articles. The most common article type was clinically focused retrospective analysis 36% (n = 18), clinically focused cohort study 10% (n = 5), and clinically focused cohort questionnaire, cross-sectional analysis, and randomized study 8% each (n = 4). 90% of articles were non-surgical (n = 45). The US Army had the greatest number of associated articles. Operation Iraqi Freedom and Operation Enduring Freedom were the most-cited conflicts. Conclusion The 50 most-cited articles relevant to military spine orthopaedics are predominantly clinically focused, arising from the US, and published in Aviation, Space, and Environmental Medicine, Spine, and The Spine Journal.
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Affiliation(s)
- Daniel D. Homeier
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Daniel Kang
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Robert Molinari
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, MedStar Health, Columbia, MD, USA
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Marotte L, Marsaa H, Robin N, Sellier A, Beucler N, Thefenne L, Dagain A, Joubert C. Neurosurgical Consultation Referral from the Forces: Regarding 328 Patients Referred to the Department of Neurosurgery, Sainte Anne Military Hospital, France. Mil Med 2024; 189:1114-1122. [PMID: 37032562 DOI: 10.1093/milmed/usad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION There are little data regarding elective referral to the military specialist, especially considering common pathologies such as spinal diseases, which, in the French forces, involve military neurosurgeons. An overview of the management of the military patient referred to neurosurgery consultation, especially considering spinal diseases that both constitute an operational healthissue in the forces and appear of special interest. The objective was to describe the reasons, demographics, and care pathways, addressed to the neurosurgeon. MATERIALS AND METHODS This retrospective, single-center study focused on all military patients referred for neurosurgery consultation at Sainte Anne Military Hospital in Toulon. Extracted data included demographic characteristics, army, unit, military specialty, the reason for referral, the diagnosis by the neurosurgeon, treatment, and outcome. RESULTS From January 2018 to December 2019, 352 patients were referred for neurosurgical consultation by the unit general practitioner. Spinal disease (n = 297, 91%) was the most frequent reason. Lumbar degenerative disk disease accounted for 20% of consultations, regardless of the patient's unit or specialty. Most of the patients seen in consultation received nonsurgical management (n = 271, 82.6%). These patients mainly presented with cervical or lumbar degenerative disk disease (n = 99, 36.5%) or cervical or lumbar herniated discs (n = 57, 21.0%). Ninety-eight patients (29.9%) were referred exclusively for medical fitness assessment. Few patients experienced full resolution of their presenting complaint after management (n = 9, 2.8%). CONCLUSIONS This descriptive study demonstrates the predominance of degenerative spinal diseases in military patients referred to neurosurgery. It reflects the importance of the medical and military competence required to maintain operational capability upstream and downstream of war traumatology. The description of the care pathways invites us to define more proactive multidisciplinary pathways for the management of these diseases in the armed forces.
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Affiliation(s)
- Louis Marotte
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Hélène Marsaa
- Antenne médicale 148, 9e Centre Médical des Armées, Hyères 83400, France
| | - Nicolas Robin
- Service Médical de la Force d'Action Navale, Toulon 83000, France
| | - Aurore Sellier
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
| | - Nathan Beucler
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
| | - Laurent Thefenne
- Department of Rehabilitation, Laveran Military Hospital, Marseille 13384, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Arnaud Dagain
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Christophe Joubert
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
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Cohen SP, Larkin TM, Weitzner AS, Dolomisiewicz E, Wang EJ, Hsu A, Anderson-White M, Smith MS, Zhao Z. Multicenter, Randomized, Placebo-controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain. Anesthesiology 2024; 140:513-523. [PMID: 38079112 DOI: 10.1097/aln.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical nonsteroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics. METHODS This study was a randomized, double-blind, placebo-controlled crossover trial performed at four U.S. military, Veterans Administration, academic, and private practice sites, in which 76 patients were randomized to receive either placebo followed by lidocaine patch for 4-week intervals (group 1) or a lidocaine-then-placebo patch sequence. The primary outcome measure was mean reduction in average neck pain, with a positive categorical outcome designated as a reduction of at least 2 points in average neck pain coupled with at least a 5-point score of 7 points on the Patient Global Impression of Change scale at the 4-week endpoint. RESULTS For the primary outcome, the median reduction in average neck pain score was -1.0 (interquartile range, -2.0, 0.0) for the lidocaine phase versus -0.5 (interquartile range, -2.0, 0.0) for placebo treatment (P = 0.17). During lidocaine treatment, 27.7% of patients experienced a positive outcome versus 14.9% during the placebo phase (P = 0.073). There were no significant differences between treatments for secondary outcomes, although a carryover effect on pain pressure threshold was observed for the lidocaine phase (P = 0.015). A total of 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (P = 0.36). CONCLUSIONS The differences favoring lidocaine were small and nonsignificant, but the trend toward superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Pain Medicine Division and Departments of Physical Medicine and Rehabilitation, Neurology, Psychiatry and Neurosurgery, Northwestern Feinberg School of Medicine, Chicago, Illinois; Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas M Larkin
- Pain Management Institute, Bethesda, Maryland, and Washington, D.C
| | | | - Edward Dolomisiewicz
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annie Hsu
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mirinda Anderson-White
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Marin S Smith
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Geneva Foundation, Bethesda, Maryland
| | - Zirong Zhao
- Departments of Neurology and Internal Medicine, District of Columbia Veterans Affairs Medical Center, Washington, D.C
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Yang F, Wang Z, Zhang H, Xie B, Zhao H, Gan L, Li T, Zhang J, Chen Z, Li T, Huang X, Chen Y, Du J. Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment. Front Public Health 2023; 11:1226930. [PMID: 38026361 PMCID: PMC10643867 DOI: 10.3389/fpubh.2023.1226930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements. Methods Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs). Results A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP. Conclusion The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.
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Affiliation(s)
- Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhong Wang
- Department of Spine Surgery, Central Hospital of Dalian University of Technology, Dalian, China
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Lu Gan
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Tengfei Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Jing Zhang
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Xiaogang Huang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
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Cohen SP, Dawson TC, Pasquina PF. The Use of Opioids in the Management of Chronic Pain. Ann Intern Med 2023; 176:eL230224. [PMID: 37722121 DOI: 10.7326/l23-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Affiliation(s)
- Steven P Cohen
- Johns Hopkins School of Medicine, Baltimore, Maryland, and Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Paul F Pasquina
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland
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12
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Ziegler AML, Shannon Z, Long CR, Vining RD, Walter JA, Coulter ID, Goertz CM. Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial. J Manipulative Physiol Ther 2022; 44:690-698. [PMID: 35752500 DOI: 10.1016/j.jmpt.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). METHODS This was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. RESULTS The most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). CONCLUSION For the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.
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Affiliation(s)
- Anna-Marie L Ziegler
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | | | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | | | - Christine M Goertz
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina
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13
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Yang Y, Liu S, Ling M, Ye C. Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots: A Study Based on Questionnaire and Physical Function Assessment. Front Public Health 2022; 9:744601. [PMID: 35059371 PMCID: PMC8764305 DOI: 10.3389/fpubh.2021.744601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
Objectives: Low back pain (LBP) has negative implications for the military's combat effectiveness. This study was conducted to determine the prevalence and risk factors of LBP among pilots through a questionnaire and physical function assessments. Methods: Data on the demographic and occupational characteristics, health habits, physical activity, and musculoskeletal injuries of 217 male pilots (114 fighter, 48 helicopter, and 55 transport pilots) were collected using a self-reported questionnaire and physical function assessments. Results: LBP prevalence was 37.8% in the total cohort and 36.0, 45.8, and 34.5% among fighter, helicopter, and transport pilots, respectively. Multivariate regression analysis revealed that the risk factors significantly associated with LBP were neck pain [odds ratio (OR): 3.559, 95% confidence interval (CI): 1.827–6.934], transversus abdominis activation (OR: 0.346, 95% CI: 0.172–0.698), and hip external rotator strength (OR: 0.001, 95% CI: 0.000–0.563) in the total cohort; neck pain (OR: 3.586, 95% CI: 1.365–9.418), transversus abdominis activation (OR: 0.268, 95% CI: 0.094–0.765), hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.949), and weekly flying hours (OR: 3.889, 95% CI: 1.490–10.149) in fighter pilots; irregular strength training (OR: 0.036, 95% CI: 0.003–0.507) and hip external rotator strength (OR: 0.000, 95% CI: 0.000–0.042) in helicopter pilots; and neck pain (OR: 6.417, 95% CI: 1.424–28.909) in transport pilots. Conclusions: High volume flight schedules and weak core muscle functions have significant negative effects on pilots' back health. LBP is commonly associated with high weekly flying hours, worsening neck pain, transversus abdominis insufficient activation, and reduced hip extensor/rotator strength. Risk factors vary among pilots of different aircraft. Thus, specific core muscle training would be especially important for military pilots.
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Affiliation(s)
- Yizhuo Yang
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Shuai Liu
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Mengyu Ling
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China.,Department of Rehabilitation Medicine and Physiotherapy, Anhui Medical University, Hefei, China
| | - Chaoqun Ye
- Department of Rehabilitation Medicine, Air Force Medical Center, PLA, Beijing, China
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14
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To D, Rezai M, Murnaghan K, Cancelliere C. Risk factors for low back pain in active military personnel: a systematic review. Chiropr Man Therap 2021; 29:52. [PMID: 34969400 PMCID: PMC8719410 DOI: 10.1186/s12998-021-00409-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/16/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Low back pain (LBP) is prevalent in military personnel. We aimed to systematically review the literature regarding risk factors for first-time LBP during military service among active duty military personnel. Methods We searched six electronic databases (inception-April 2020) for randomised controlled trials, cohort studies, and case–control studies published in English in peer-reviewed journals. Eligible studies were independently critically appraised by paired reviewers and a descriptive synthesis was conducted. Results We screened 1981 records, reviewed 118 full-text articles, and synthesised data from eight acceptable quality cohort studies. Studies assessed physical (n = 4), sociodemographic (n = 2), and/or occupational factors (n = 5) associated with LBP. Two studies reported prior LBP was associated with a greater than twofold increased risk of LBP compared to those without prior LBP. Other factors consistently associated with LBP included previous musculoskeletal injury (n = 2), less time spent on physical training (n = 2), female sex (n = 2), and lower rank (n = 2). Factors associated with LBP from single studies included marital status, lower education level, blast injury, job duties, and service type. We found inconsistent associations for performance on physical fitness tests, age, and occupation type. Psychological risk factors were not assessed in any included studies. Conclusion In active duty personnel, prior history of LBP, previous musculoskeletal injury, less time in physical training, female sex, and lower rank were consistent risk factors for LBP. This information is relevant for researchers, active duty military personnel, and other decision makers. Future studies should explore causal relationships for LBP in this population. PROSPERO registration number: CRD42018084549. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00409-x.
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Affiliation(s)
- Daphne To
- Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Mana Rezai
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, ON, Canada
| | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, Oshawa, ON, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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15
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Kenareh R, Mirmohammadi SJ, Khatibi A, Shamsi F, Mehrparvar AH. The Comparison of The Efficacy of Photobiomodulation and Ultrasound in the Treatment of Chronic Non-specific Neck Pain: A Randomized Single-Blind Controlled Trial. J Lasers Med Sci 2021; 12:e20. [PMID: 34733743 DOI: 10.34172/jlms.2021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Chronic neck pain is a common complaint among office workers. The aim of the present study was to compare the efficacy of a high-intensity laser and physiotherapy in office workers who were diagnosed with chronic non-specific neck pain. Methods: This study was a single-blind randomized controlled trial, with parallel allocation. Sixty office workers with chronic neck pain, aged between 25 and 55 years, participated in the study. The participants were randomly divided into two groups: photobiomodulation (by a high-level laser) and physiotherapy. Visual analogue scale (VAS), Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS) and Bournemouth Questionnaire (BQN) were completed on three occasions (before, immediately and 2 weeks after the intervention) to assess and compare the efficacy of the high-intensity laser and physiotherapy in neck pain. Data were analyzed by SPSS 23 software using the chi-square test, Student's t test, multivariate tests, and Fisher's exact test. Results: The mean age of the participants was 37.53±9.52 and 41.16±7.85 years in physiotherapy and laser therapy respectively. The VAS score and NDI scores decreased after both kinds of interventions, and the effect of photobiomodulation was significantly higher than physiotherapy (P < 0.001). Both treatment modalities significantly affect different aspects of chronic neck pain assessed by NDPS and BQN questionnaires and the effect of photobiomodulation was more prominent than physiotherapy. Conclusion: The findings of this study showed that photobiomodulation and physiotherapy can reduce chronic neck pain and its different aspects and the effect of laser therapy was significantly higher than physiotherapy.
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Affiliation(s)
- Rahele Kenareh
- Occupational Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Amidoddine Khatibi
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farimah Shamsi
- Abortion Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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16
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Rhon DI, Fritz JM, Greenlee TA, Dry KE, Mayhew RJ, Laugesen MC, Dragusin E, Teyhen DS. Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial. J Transl Med 2021; 19:357. [PMID: 34407840 PMCID: PMC8371880 DOI: 10.1186/s12967-021-03013-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. METHODS The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. DISCUSSION Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. TRIAL REGISTRATION Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
| | | | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Katie E Dry
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Rachel J Mayhew
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Mary C Laugesen
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Edita Dragusin
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA
| | - Deydre S Teyhen
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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17
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Barassi JP. What Would it Take to Put a Chiropractor in Khakis? Effecting Chiropractors as Commissioned Officers in the U.S. Military-A Historical Brief. Mil Med 2021; 187:23-28. [PMID: 34331452 DOI: 10.1093/milmed/usab324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U.S. Military and to propose a pathway by which this can be accomplished. A comprehensive review of Congressional actions proposed and enacted, and historical documents to create a chronology of actions that influence and support a proposed pathway for commissioning. The authority to commission chiropractors within the U.S. Military has long been provided to the Secretary of Defense, but it has never been acted upon despite decades of legislation. Chiropractors currently serve within the DoD as contractors or government employees; however, the direct association with the military in terms of commissioning has remained elusive. Musculoskeletal injuries are statistically one of the most prevalent combat-related injury classifications within the active duty military and subsequent veteran population. Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.
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Affiliation(s)
- James P Barassi
- Department of Pain Management, Veterans Administration Medical Center, Manchester, NH 03104, USA
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18
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Walsh GS, Harrison I. Gait and neuromuscular dynamics during level and uphill walking carrying military loads. Eur J Sport Sci 2021; 22:1364-1373. [PMID: 34231431 DOI: 10.1080/17461391.2021.1953154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The neuromuscular system responds to perturbation and increasing locomotor task difficulty by altering the stability of neuromuscular output signals. The purpose of this study was to determine the effects of two different military load carriage systems on the dynamic stability of gait and muscle activation signals. 14 army office cadets (20 ± 1 years) performed 4-minute treadmill walking trials on level (0%) and uphill (10%) gradients while unloaded, and with 11 kg backpack and 11 kg webbing loads while the activity of 6 leg and trunk muscles and the motion of the centre of mass (COM) were recorded. Loaded and uphill walking decreased stability and increased magnitude of muscle activations compared to loaded and level gradient walking. Backpack loads increased the medio-lateral stability of COM and uphill walking decreased stability of vertical COM motion and increased stride time variability. However, there was no difference between the two load carriage systems for any variable. The reduced stability of muscle activations in loaded and uphill conditions indicates an impaired ability of the neuromuscular control systems to accommodate perturbations in these conditions which may have implications on the operational performance of military personnel. However, improved medio-lateral stability in backpack conditions may indicate that participants were able to compensate for the loads used in this study, despite the decreased vertical stability and increased stride time variability evident in uphill walking. This study did not find differences between load carriage systems however, specific load carriage system effects may be elicited by greater load carriage masses.Highlights Loaded and uphill walking decreased dynamic stability of muscle activationsLower activation stability indicates impaired neuromotor resistance to perturbationBackpack and webbing loads produced similar effects on muscle activations.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Isabel Harrison
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
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Gomes SRA, Mendes PRF, Costa LDO, Bulhões LCC, Borges DT, Macedo LB, Brasileiro J. Factors associated with low back pain in air force fighter pilots: a cross-sectional study. BMJ Mil Health 2021; 168:299-302. [PMID: 34266971 DOI: 10.1136/bmjmilitary-2021-001851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/23/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Low back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions. METHODS This is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors. RESULTS It was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both). CONCLUSION There was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.
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Affiliation(s)
| | - P R F Mendes
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L D O Costa
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L C C Bulhões
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - D T Borges
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ld B Macedo
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J Brasileiro
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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20
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Walsh GS, Low DC. Military load carriage effects on the gait of military personnel: A systematic review. APPLIED ERGONOMICS 2021; 93:103376. [PMID: 33540208 DOI: 10.1016/j.apergo.2021.103376] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Carrying heavy loads results in biomechanical changes to gait and to an increased risk of injury in soldiers. The aim of this review is to examine the effects of military specific load carriage on the gait of soldiers. The Web of Science, PubMed and CINAHL databases were searched, a total of 1239 records were screened and 20 papers were included in the review. Participant, load and task characteristics and a summary of key findings were extracted. Due to heterogeneity in the reviewed studies, analysis was restricted to qualitative synthesis. There were limited effects on spatio-temporal variables but consistently reported increased trunk, hip and knee flexion and increased hip and knee extension moments. Muscle activation of lower limb and trunk muscles were also increased with loads. However, there were some conflicting findings for most parameters reviewed and apart from spatio-temporal parameters the findings of this review were in line with previous reviews of combined military and civilian populations.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - Daniel C Low
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, UK
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21
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Hughey S, Cole J, Booth G, Moore J, McDowell B, DeYoung H, Hosig A, Moran T, Stedje-Larsen E. Predicting Treatment Success with Facet Syndrome: An Algorithm to Predict Lumbar Radiofrequency Ablation Responders in a Military Population. PAIN MEDICINE 2021; 22:266-272. [PMID: 33166391 DOI: 10.1093/pm/pnaa381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) of the medial branch nerve is a commonly performed procedure for patients with facet syndrome. RFA has previously been demonstrated to provide long-term functional improvement in approximately 50% of patients, including those who had significant pain relief after diagnostic medial branch block. We sought to identify factors associated with success of RFA for facet pain. DESIGN Active-duty military patients who underwent lumbar RFA (L3, L4, and L5 levels) over a 3-year period were analyzed. Defense and Veterans Pain Rating Scale (DVPRS) and Oswestry Disability Index (ODI) scores were assessed the day of procedure and at the 2-month and 6-month follow-up. These data were analyzed to identify associations between patient demographics, pain, and functional status and patients' improvement after RFA, with a primary outcome of ODI improvement and a secondary outcome of pain reduction. RESULTS Higher levels of starting functional impairment (starting ODI scores of 42.9 vs. 37.5; P = 0.0304) were associated with a greater likelihood of improvement in functional status 6 months after RFA, and higher starting pain scores (DVPRS pain scores of 6.1 vs. 5.1; P < 0.0001) were associated with a higher likelihood that pain scores would improve 6 months after RFA. A multivariate logistic regression was then used to develop a scoring system to predict improvement after RFA. The scoring system generated a C-statistic of 0.764, with starting ODI, pain scores, and both gender and smoking history as independent variables. CONCLUSIONS This algorithm compares favorably to that of diagnostic medial branch block in terms of prediction accuracy (C-statistic of 0.764 vs. 0.57), suggesting that its use may improve patient selection in patients who undergo RFA for facet syndrome.
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Affiliation(s)
- Scott Hughey
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Jacob Cole
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Gregory Booth
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Jeffrey Moore
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Benjamin McDowell
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Henry DeYoung
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Anna Hosig
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Thomas Moran
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Eric Stedje-Larsen
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
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22
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Rae L, Dougherty P, Evertz N. Yoga vs Stretching in Veterans With Chronic Lower Back Pain and the Role of Mindfulness: A Pilot Randomized Controlled Trial. J Chiropr Med 2020; 19:101-110. [PMID: 33318728 DOI: 10.1016/j.jcm.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 10/23/2022] Open
Abstract
Objective The purpose of this study was to investigate the feasibility of recruiting, randomizing, enrolling, and collecting outcome data on veteran patients with chronic low back pain (CLBP) who undergo an 8-week, active exercise class with mindfulness (yoga class) and without (stretching class). Methods United States veterans with CLBP based on inclusion/exclusion criteria were randomized to 1 of 2 groups. The study design was a pilot randomized controlled trial. Twenty CLBP patients attended a yoga class or stretching class once per week for 8 weeks at the Veterans Affairs Rochester Outpatient Center, Rochester, New York. The following measurements were obtained: recruitment or enrollment data, compliance data to include class attendance and home exercise, and compliance data regarding ability to collect outcome measures at baseline and at completion. Outcome measures included pain (PEG), quality of life (PROMIS Global Health Survey), self-efficacy (2-item questionnaire), fear avoidance belief, catastrophizing, and social engagement in addition to qualitative clinician open-ended questions postintervention. Results Forty-five veterans were queried regarding interest in participation. Of these, 34 (76%) met the study's criteria. Twenty (44%) agreed to participate and were consented, randomized, and enrolled in the study. Initial and final outcome measures were obtained for each participant (100%). Forty percent attended more than 80% of the sessions for both yoga and stretching groups. Conclusion This pilot study demonstrated feasibility of recruiting, enrolling, and collecting outcome data on CLBP veteran patients participating in yoga and stretching class. The data from this pilot will inform the development of a randomized, comparative effectiveness study of yoga with and without mindfulness in the management of CLBP.
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Affiliation(s)
- Lindsay Rae
- Department of Clinical Education, New York Chiropractic College, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Paul Dougherty
- Department of Clinical Education, New York Chiropractic College, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Nicholas Evertz
- Geriatrics and Extended Care and Rehabilitation (GEC-R), VA Finger Lakes Healthcare System, Canandaigua, New York
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23
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Fritz JM, Rhon DI, Teyhen DS, Kean J, Vanneman ME, Garland EL, Lee IE, Thorp RE, Greene TH. A Sequential Multiple-Assignment Randomized Trial (SMART) for Stepped Care Management of Low Back Pain in the Military Health System: A Trial Protocol. PAIN MEDICINE 2020; 21:S73-S82. [PMID: 33313724 DOI: 10.1093/pm/pnaa338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus areas. A stepped care model focused on nonpharmacologic treatment to promote self-management is recommended. Implementation of stepped care is complicated by lack of information on the most effective nonpharmacologic strategies and how to sequence and tailor the various available options. The Sequential Multiple-Assignment Randomization Trial for Low Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to assess the effectiveness of nonpharmacologic treatments for chronic low back pain. DESIGN This SMART trial has two treatment phases. Participants from three military treatment facilities are randomized to 6 weeks of phase I treatment, receiving either physical therapy (PT) or Army Medicine's holistic Move2Health (M2H) program in a package specific to low back pain. Nonresponders to treatment in phase I are again randomized to phase II treatment of combined M2H + PT or mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement Information System pain interference computer-adapted test score. SUMMARY This trial is part of an initiative funded by the National Institutes of Health, Veterans Affairs, and the Department of Defense to establish a national infrastructure for effective system-level management of chronic pain with a focus on nonpharmacologic treatments. The results of this study will provide important information on nonpharmacologic care for chronic LBP in the MHS embedded within a stepped care framework.
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Affiliation(s)
| | - Daniel I Rhon
- Brooke Army Medical Center, San Antonio, Texas.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Deydre S Teyhen
- Walter Reed Army Institute of Research, Silvers Spring, Maryland
| | - Jacob Kean
- University of Utah, Salt Lake City, Utah
| | | | | | - Ian E Lee
- Defense Health Management Systems, Falls Church, Virginia
| | - Richard E Thorp
- Directorate of Program Analysis and Evaluation, Office of the Army Surgeon General, Joint Base San Antonio Fort Sam Houston, San Antonio, Texas, USA
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Farrokhi S, Russell Esposito E, McPherson D, Mazzone B, Condon R, Patterson CG, Schneider M, Greco CM, Delitto A, Highsmith MJ, Hendershot BD, Maikos J, Dearth CL. Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE): Protocol for a Multisite Pragmatic Clinical Trial. PAIN MEDICINE 2020; 21:S45-S52. [PMID: 33313735 DOI: 10.1093/pm/pnaa367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (CPGs) can improve the outcomes and cost-effectiveness of LBP care, PT CPG adherence remains below 50%. The Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE) trial will evaluate the effectiveness of an active PT CPG implementation strategy using an education, audit, and feedback model for reducing pain, disability, medication use, and cost of LBP care within the DOD and VA health care systems. DESIGN The RESOLVE trial will include 3,300 to 7,260 patients with LBP across three DOD and two VA medical facilities using a stepped-wedge study design. An education, audit, and feedback model will be used to encourage physical therapists to better adhere to the PT CPG recommendations. The Oswestry Disability Index and the Defense and Veterans Pain Rating Scale will be used as primary outcomes. Secondary outcomes will include the LBP-related medication use, medical resource utilization, and biopsychosocial predictors of outcomes. Statistical analyses will be based on the intention-to-treat principle and will use linear mixed models to compare treatment conditions and examine the interactions between treatment and subgrouping status (e.g., limb loss). SUMMARY The RESOLVE trial will provide a pragmatic approach to evaluate whether better adherence to PT CPGs can reduce pain, disability, medication use, and LBP care cost within the DOD and VA health care systems.
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Affiliation(s)
- Shawn Farrokhi
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Naval Medical Center San Diego, San Diego, California
| | - Elizabeth Russell Esposito
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Danielle McPherson
- Naval Medical Center San Diego, San Diego, California.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Brittney Mazzone
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Naval Medical Center San Diego, San Diego, California
| | - Rachel Condon
- Naval Medical Center San Diego, San Diego, California
| | | | | | | | | | - M Jason Highsmith
- US Department of Veterans Affairs, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Brad D Hendershot
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jason Maikos
- US Department of Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
| | - Christopher L Dearth
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
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25
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Feki F, Taktak R, Kandil K, Derrouiche A, Moulart M, Haddar N, Zaïri F, Zaïri F. How Osmoviscoelastic Coupling Affects Recovery of Cyclically Compressed Intervertebral Disc. Spine (Phila Pa 1976) 2020; 45:E1376-E1385. [PMID: 33031252 DOI: 10.1097/brs.0000000000003593] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Osmoviscoelastic behavior of cyclically loaded cervical intervertebral disc. OBJECTIVE The aim of this study was to evaluate in vitro the effects of physiologic compressive cyclic loading on the viscoelastic properties of cervical intervertebral disc and, examine how the osmoviscoelastic coupling affects time-dependent recovery of these properties following a long period of unloading. SUMMARY OF BACKGROUND DATA The human neck supports repetitive loadings during daily activities and recovery of disc mechanics is essential for normal mechanical function. However, the response of cervical intervertebral disc to cyclic loading is still not very well defined. Moreover, how loading history conditions could affect the time-dependent recovery is still unclear. METHODS Ten thousand cycles of compressive loading, with different magnitudes and saline concentrations of the surrounding fluid bath, are applied to 8 motion segments (composed by 2 adjacent vertebrae and the intervening disc) extracted from the cervical spines of mature sheep. Subsequently, specimens are hydrated during 18 hours of unloading. The viscoelastic disc responses, after cyclic loading and recovery phase, are characterized by relaxation tests. RESULTS Viscoelastic behaviors are significantly altered following large number of cyclic loads. Moreover, after 18-hour recovery period in saline solution at reference concentration (0.15 mol/L), relaxation behaviors were fully restored. Nonetheless, full recovery is not obtained whether the concentration of the surrounding fluid, that is, hypo-, iso-, or hyper-osmotic conditions. CONCLUSION Cyclic loading effects and full recovery of viscoelastic behavior after hydration at iso-osmotic condition (0.15 mol/L) are governed by osmotic attraction of fluid content in the disc due to imbalance between the external load and the swelling pressure of the disc. After removal of the load, the disc recovers its viscoelastic properties following period of rest. Nevertheless, the viscoelastic recovery is a chemically activated process and its dependency on saline concentration is governed by fluid flow due to imbalance of ions between the disc tissues and the surrounding fluid. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Faten Feki
- ENIS, Materials Engineering and Environment Laboratory (LGME), Sfax, Tunisia
| | - Rym Taktak
- ENIS, Materials Engineering and Environment Laboratory (LGME), Sfax, Tunisia
| | - Karim Kandil
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | - Amil Derrouiche
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | | | - Nader Haddar
- ENIS, Materials Engineering and Environment Laboratory (LGME), Sfax, Tunisia
| | - Fahmi Zaïri
- Lille University, Civil Engineering and geo-Environmental Laboratory (ULR 4515 LGCgE), Lille, France
| | - Fahed Zaïri
- Ramsay Générale de Santé, Hôpital privé Le Bois, Lille, France
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26
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Cohen SP, Baber ZB, Buvanendran A, McLean BC, Chen Y, Hooten WM, Laker SR, Wasan AD, Kennedy DJ, Sandbrink F, King SA, Fowler IM, Stojanovic MP, Hayek SM, Phillips CR. Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises. PAIN MEDICINE 2020; 21:1331-1346. [PMID: 32259247 PMCID: PMC7184417 DOI: 10.1093/pm/pnaa127] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for. METHODS To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week period. RESULTS In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization. CONCLUSIONS The COVID-19 public health crisis has strained health care systems, creating a conundrum for patients, pain medicine practitioners, hospital leaders, and regulatory officials. Although this document provides a framework for pain management services, systems-wide and individual decisions must take into account clinical considerations, regional health conditions, government and hospital directives, resource availability, and the welfare of health care providers.
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Affiliation(s)
- Steven P Cohen
- Anesthesiology, Neurology and Physical Medicine and Rehabilitation, Pain Medicine, Johns Hopkins School of Medicine, Maryland.,Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zafeer B Baber
- Division of Anesthesiology and Interventional Pain Management, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Asokumar Buvanendran
- Anesthesiology and Orthopedic Surgery, Rush University College of Medicine, Chicago, Illinois
| | - Brian C McLean
- US Army Pain Management Consultant, Pain Management, Department of Anesthesiology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Yian Chen
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - W Michael Hooten
- Anesthesiology and Psychiatry, Mayo School of Medicine, Rochester, Minnesota
| | - Scott R Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado
| | - Ajay D Wasan
- Anesthesiology and Psychiatry, Pain Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David J Kennedy
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Friedhelm Sandbrink
- Pain Management Specialty Services Director, Veterans Health Administration, Washington DC VA Medical Center, Washington, DC
| | - Scott A King
- US Air Force Pain Management Consultant, Eglin Air Force Base, Florida
| | - Ian M Fowler
- US Navy Pain Management Consultant, Director of Surgical Services, Naval Medical Center-San Diego, San Diego, California
| | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, Interventional Pain Medicine, Edith Nourse Rogers Memorial Veterans Hospital, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
| | - Salim M Hayek
- Department of Anesthesiology, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christopher R Phillips
- Department of Surgery, Anesthesiology Service, Naval Medical Center- San Diego, California, USA
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Talbot LA, Wilson C, Nayback-Beebe A, Metter EJ, Hatzfeld J. Nursing's Role in Preventing and Managing Back Pain in Military Members: Proceedings of the First Back Pain Summit. Mil Med 2020; 185:43-49. [PMID: 32561931 DOI: 10.1093/milmed/usz238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This is a review of the proceedings of the first Military Nursing Back Pain Summit focusing on nursing's role in preventing and managing back pain. The purpose of the summit was to present the state of the science in back pain and to identify key gaps in research, policy, education, and treatment that could be undertaken by military nurses, nurse leaders, nurse practitioners, and nurse scientists. Several key points were highlighted during the summit: (1) back pain is multifactorial and preventable; (2) military service members have unique risk factors for developing back pain; (3) both acute and chronic back pain impact readiness and sustaining readiness is the primary mission of military medicine; (4) back pain is most effectively managed with multiple treatment approaches; (5) military culture must pivot away from an attitude of ignoring persistent pain or "toughing it out" to prevent acute back pain from becoming chronic; (6) integrating military nurses within operational units will be important for effective prevention, education, screening, and treatment within dispersed Multi-Domain Operations; and (7) early self-management is an important area for nursing research and intervention to empower service members to maintain and sustain their back health. The various presentations and panels from the meeting are summarized.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
| | - Candy Wilson
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ann Nayback-Beebe
- Clinical & Rehabilitative Medicine Research Program (CRMRP), US Army Medical Research and Materiel Command (USAMRMC), 504 Scott Street, Fort Detrick, MD 21702-5012
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
| | - Jennifer Hatzfeld
- TriService Nursing Research Program, Uniform Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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28
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Tegern M, Aasa U, Äng BO, Larsson H. Musculoskeletal disorders and their associations with health- and work-related factors: a cross-sectional comparison between Swedish air force personnel and army soldiers. BMC Musculoskelet Disord 2020; 21:303. [PMID: 32408863 PMCID: PMC7227099 DOI: 10.1186/s12891-020-03251-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high numbers of musculoskeletal disorders (MSD) among soldiers in the Swedish Armed Forces has led to the implementation of an effective prevention program, the musculoskeletal screening protocol (MSP), including questionnaires, physical tests and individual intervention of their MSD. A corresponding MSP for the Swedish Air Force is also needed due to earlier reported high prevalence of MSD. We therefore investigated the prevalence of MSD in Swedish Air Force personnel (AF) and compared this to Swedish Army deployed soldiers (DS). Individual, health- and work-related factors associated with MSD were also investigated. METHODS Cross-sectional questionnaire-based study on 166 male AF and 185 DS. AF consisted of fighter pilots, helicopter pilots and rear crew from one Swedish air base. RESULTS The one-year and point prevalence, respectively, of MSD were significantly higher for AF compared to DS with regard to both the upper quarter of the body (i.e. neck, shoulder and thoracic regions) (AF = 54.8 and 31.3%, DS = 26.1 and 13.6%, p = 0.01) and the lumbar region (AF = 38.0 and 18.7%, DS = 22.2 and 7.1%, p = 0.00). No significant differences were present between fighter pilots, helicopter pilots and rear crew regarding MSD prevalence. Factors significantly associated with having both upper quarter and lumbar regions MSD were group (i.e. greater odds for AF than DS) and self-reported physical health as less than excellent. Additionally, being older and taller were also factors associated with lumbar region MSD. DISCUSSION Despite a generally healthy lifestyle, MSD were commonly reported by AF and DS, with generally higher prevalence in AF who mainly reported MSD in the upper quarter of the body. The results from this study indicate that the MSP can be a meaningful tool to prevent MSD in air force personnel and that questions regarding general health and MSD in specific body regions should be included in screening protocols. The development of the preventive program MSP is therefore recommended for the Swedish Air Force.
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Affiliation(s)
- Matthias Tegern
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
| | - Ulrika Aasa
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå, Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Centre for Clinical Research Dalarna - Uppsala University, Falun, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Swedish Armed Forces, HQ, Stockholm, Sweden
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29
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Sessoms PH, Gobrecht M, Niederberger BA, Sturdy JT, Collins JD, Dominguez JA, Jaworski RL, Kelly KR. Effect of a load distribution system on mobility and performance during simulated and field hiking while under load. ERGONOMICS 2020; 63:133-144. [PMID: 31709928 DOI: 10.1080/00140139.2019.1690710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
This study was conducted to test a modular scalable vest-load distribution system (MSV-LDS) against the plate carrier system (PC) currently used by the United States Marine Corps. Ten Marines engaged in 1.6 km load carriage trials in seven experimental conditions in a laboratory study. Kinematic, kinetic, and spatiotemporal gait parameters, muscle activity (electromyography), heart rate, caloric expenditure, shooting reaction times, and subjective responses were recorded. There was lower mean trapezius recruitment for the PC compared with the MSV-LDS for all conditions, and muscle activity was similar to baseline for the MSV-LDS. Twenty-seven Marines carrying the highest load were evaluated in the field, which measured an increase in energy expenditure with MSV-LDS; however, back discomfort was reduced. The field evaluation showed significantly reduced estimated ground reaction force on flat-ground segments with the MSV-LDS, and the data suggest both systems were comparable with respect to mobility and energy cost. Practitioner summary: This study found that a novel load distribution system appears to redistribute load for improved comfort as well as reduce estimated ground reaction force when engaged in hiking activities. Further, hiking with a load distribution system enables more neutral walking posture. Implications of load differences in loads carried are examined. Abbreviations: AGRF: anterior-posterior ground reaction forces; CAREN: Computer Assisted Rehabilitation Environment; GRF: ground reaction forces; HR: heart rate; ML-GRF: mediolateral ground reaction forces; MOLLE: Modular Lightweight Load-carrying Equipment; MSV-LDS: modular scalable vest-load distribution system; NHRC: Naval Health Research Center; PC: plate carrier; PPE: personal protective equipment; RPE: rating of perceived exertion; SAPI: small arms protective insert; sEMG: surface electromyography; USMC: United States Marine Corps; VGRF: Ground reaction forces in the vertical.
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Affiliation(s)
- Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Marcus Gobrecht
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | | | | | | | - Jose A Dominguez
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Rebecca L Jaworski
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Karen R Kelly
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
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Kerns RD, Brandt CA, Peduzzi P. NIH-DoD-VA Pain Management Collaboratory. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:2336-2345. [PMID: 31807788 PMCID: PMC6895460 DOI: 10.1093/pm/pnz186] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Robert D Kerns
- VA Connecticut Healthcare System, West Haven, Connecticut
| | | | - Peter Peduzzi
- Yale University School of Medicine, New Haven, Connecticut, USA
- Please see the Appendix for the complete list of authors and affiliations
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Koehlmoos TP, Madsen CK, Banaag A, Haider AH, Schoenfeld AJ, Weissman JS. Assessing Low-Value Health Care Services In The Military Health System. Health Aff (Millwood) 2019; 38:1351-1357. [DOI: 10.1377/hlthaff.2019.00252] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tracey Pérez Koehlmoos
- Tracey Pérez Koehlmoos is an associate professor of preventive medicine and biostatistics and principal investigator of the Health Services Research Program, Uniformed Services University of the Health Sciences, in Bethesda, Maryland
| | - Cathaleen King Madsen
- Cathaleen King Madsen is a program manager in the Health Services Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, in Bethesda, Maryland
| | - Amanda Banaag
- Amanda Banaag is a data analyst in the Comparative Effectiveness and Provider Induced Demand Collaboration, Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Adil H. Haider
- Adil H. Haider is the dean of the Medical College, Aga Khan University, in Karachi, Pakistan, and the director of disparities and emerging trauma systems in the Center for Surgery and Public Health, Brigham and Women’s Hospital and Harvard Medical School, both in Boston, Massachusetts
| | - Andrew J. Schoenfeld
- Andrew J. Schoenfeld is an associate professor in the Center for Surgery and Public Health, Harvard Medical School, and an associate professor in the Department of Orthopaedic Surgery, Brigham and Women’s Hospital
| | - Joel S. Weissman
- Joel S. Weissman is a professor in the Center for Surgery and Public Health, Harvard Medical School
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Estep PN, Bonts EG, Shivers BL, Wurzbach JM, Novotny BL, Rybarczyk K, Chancey VC. Mass Properties Comparison of Dismounted and Ground-Mounted Head-Supported Mass Configurations to Existing Performance and Acute Injury Risk Guidelines. Mil Med 2019; 184:245-250. [PMID: 30901469 DOI: 10.1093/milmed/usy342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/26/2018] [Indexed: 11/12/2022] Open
Abstract
In order to limit the aviator's exposure to potentially unsafe helmet configurations, the U.S. Army Aeromedical Research Laboratory (USAARL) developed the USAARL Head-supported mass (HSM) Performance Curve and Acute Injury Risk Curve as guidelines for Army aviation HSM. These Curves remain the only established guidelines for Army HSM, but have limited applicability outside of the aviation environment. Helmet developers and program managers have requested guidelines be developed for the dismounted, ground-mounted, and airborne operating environments that consider currently fielded and proposed HSM configurations. The aim of this project was to measure mass properties (mass and center of mass offset) of currently fielded and proposed HSM configurations and compare them against the existing USAARL HSM Curve guidelines. Mass properties were collected for 71 unique dismounted and ground-mounted HSM configurations. None of the 71 HSM configurations met the Acute Injury Risk Curve recommendations, and only 11 of the 71 configurations met Performance Curve recommendations. While some helmets fell within acceptable limits, the addition of night vision goggles and protective masks pushed all configurations outside of the recommended guidelines. Future guidelines will need to be expanded to consider the operating environment, movement techniques, and primary mechanism of injury.
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Affiliation(s)
- Patrick N Estep
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Emily G Bonts
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,OakRidge Institute for Science and Education, 100 ORAU Way, Oak Ridge, TN
| | - Bethany L Shivers
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
| | - John M Wurzbach
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Brian L Novotny
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL.,Laulima Government Solutions, LLC, 12565 Research Pkwy, Suite 300, Orlando, FL
| | - Kyle Rybarczyk
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
| | - Valeta Carol Chancey
- Injury Biomechanics Division, U.S. Army Aeromedical Research Laboratory, 6901 Farrel Road, Ft. Rucker, AL
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The Current State of Neurosurgery in Haiti. World Neurosurg 2019; 124:208-213. [PMID: 30660896 DOI: 10.1016/j.wneu.2018.12.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Even though surgical conditions account for as much as 32% of the global burden of disease, 5 billion people worldwide do not have access to timely, affordable surgical and anesthetic care. Access to surgical care is separated along socioeconomic divides, and these disparities are most pronounced in low-and middle-income countries, such as the Caribbean nation of Haiti, where the availability of specialty surgical services like neurosurgery are scant, or completely absent. METHODS This paper provides a narrative account of current neurosurgery-related activity in Haiti, a nation whose social, political, and economic context is unique in the Americas. RESULTS After some background information and a bibliometric analysis of recent research efforts, we provide brief biographical sketches of Haiti's local neurosurgical leaders and an overview of recent initiatives in Haitian neurosurgical capacity building. CONCLUSIONS The paper concludes with recommendations to guide the international neurosurgery community in future contributions.
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34
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Effectiveness and Downstream Healthcare Utilization for Patients That Received Early Physical Therapy Versus Usual Care for Low Back Pain: A Randomized Clinical Trial. Spine (Phila Pa 1976) 2018; 43:1313-1321. [PMID: 29489568 DOI: 10.1097/brs.0000000000002619] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The aim of this study was to compare early physical therapy versus usual care in patients with low back pain. SUMMARY OF BACKGROUND DATA Early physical therapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system. METHODS Military service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physical therapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year. Analysis of covariance was used to compare differences between groups, significance set at 0.05. TRIAL REGISTRATION clinicaltrials.gov: NCT01556581 RESULTS.: A total of 119 patients (mean age 27.2 years; mean BMI 27.8 kg/m; 15.1% female) enrolled (61 randomized to UC; 58 to PT). No between-group differences found on the Oswestry after 1 year. A between-group difference in Oswestry was present at 4 weeks (mean difference = 4.4; 95% CI: 0.41-10.1; P = 0.042) favoring PT. Total 1-year mean healthcare costs did not differ significantly between groups (UC $5037; 95 CI $4171-$6082 and PT $5299; 95 CI $4367-$6431). The portion of total mean healthcare costs related to low back pain was lower for UC ($1096; 95% CI $855-$1405) compared to PT ($2016, 95% CI $1570-$2590). CONCLUSION There was no difference between usual care and early PT after 1 year. PT provided greater improvement in disability after 4 weeks. As both groups improved, the impact of the education may have been underestimated. Patients in the PT group utilized greater back-pain-related healthcare resources, but overall healthcare costs did not differ compared to UC. LEVEL OF EVIDENCE 2.
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Umale S, Yoganandan N. Mechanisms of Cervical Spine Disc Injury under Cyclic Loading. Asian Spine J 2018; 12:910-918. [PMID: 30213175 PMCID: PMC6147880 DOI: 10.31616/asj.2018.12.5.910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/19/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Determination of human cervical spine disc response under cyclic loading. PURPOSE To explain the potential mechanisms of intervertebral disc injury caused by cyclic loading. OVERVIEW OF LITERATURE Certain occupational environments in civilian and military populations may affect the cervical spine of individuals by cyclic loading. Research on this mechanism is scarce. METHODS Here, we developed a finite element model of the human C4-C5 disc. It comprised endplates, five layers of fibers, a nucleus, and an annulus ground substance. The endplates, ground substance, and annular fibers were modeled with elastic, hyperviscoelastic, and hyper-elastic materials, respectively. We subjected the disc to compressive loading (150 N) for 10,000 cycles at frequencies of 2 Hz (low) and 4 Hz (high). We measured disc displacements over the entire loading period. We obtained maximum and minimum principal stress and strain and von Mises stress distributions at both frequencies for all components. Further, we used contours to infer potential mechanisms of internal load transfer within the disc components. RESULTS The points of the model disc displacement versus the loading cycles were within the experimental corridors for both frequencies. The principal stresses were higher in the ground matrix, maximum stress was higher in the anterior and posterior annular regions, and minimum stress was higher along the superior and inferior peripheries. The maximum principal strains were radially directed, whereas the minimum principal strains were axially/obliquely directed. The stresses in the fibers were greater and concentrated in the posterolateral regions in the innermost layer. CONCLUSIONS Disc displacement was lower at high frequency, thus exhibiting strain rate stiffening and explaining stress accumulation at superior and interior peripheries. Greater stresses and strains at the boundaries explain disc injuries, such as delamination. The greater development of stresses in the innermost annular fiber layer (migrating toward the posterolateral regions) explains disc prolapse.
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Affiliation(s)
- Sagar Umale
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Center for NeuroTrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Granger E, Prada S, Bereczki Z, Weiss M, Wade C, Davis R. Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center. Mil Med 2018; 183:e619-e623. [PMID: 29788356 DOI: 10.1093/milmed/usx104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. METHODS The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. FINDINGS Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. DISCUSSION The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.
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Affiliation(s)
- Elder Granger
- Capital Technology Information Services, 1 Research Ct #200, Rockville, MD
| | - Stefan Prada
- Department of Neurosurgery, Laser Spine Institute, Avion Park Dr, Tampa, FL
| | - Zoltan Bereczki
- Department of Neurosurgery, Laser Spine Institute, Avion Park Dr, Tampa, FL
| | - Michael Weiss
- Department of Neurosurgery, Laser Spine Institute, Avion Park Dr, Tampa, FL
| | - Chip Wade
- Department of Industrial and Systems Engineering, Auburn University, 3301-G Shelby Center, Auburn, AL
| | - Reginald Davis
- Department of Neurosurgery, Laser Spine Institute, Avion Park Dr, Tampa, FL
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Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA Netw Open 2018; 1:e180105. [PMID: 30646047 PMCID: PMC6324527 DOI: 10.1001/jamanetworkopen.2018.0105] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability. OBJECTIVE To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone. DESIGN, SETTING, AND PARTICIPANTS A 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source. INTERVENTIONS The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies. MAIN OUTCOMES AND MEASURES Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0-24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12. RESULTS Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, -1.1; 95% CI, -1.4 to -0.7), disability (mean difference, -2.2; 95% CI, -3.1 to -1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13-0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54-0.97). No serious related adverse events were reported. CONCLUSIONS AND RELEVANCE Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01692275.
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Affiliation(s)
- Christine M. Goertz
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, Iowa
| | - Cynthia R. Long
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, Iowa
| | - Robert D. Vining
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, Iowa
| | | | - Joan Walter
- Samueli Institute for Information Biology, Silver Spring, Maryland
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Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study. Spine (Phila Pa 1976) 2016; 41:1754-1763. [PMID: 27310026 PMCID: PMC5113251 DOI: 10.1097/brs.0000000000001739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is scarce. To our knowledge, this is the first study to prospectively assess deployment and self-reported recent back pain in a population-based U.S. military cohort. SUMMARY OF BACKGROUND DATA The study consisted of Millennium Cohort participants who were followed for the development of back pain for an average of 3.9 years. METHODS Descriptive statistics and longitudinal analyses were used to assess the temporal relationship of deployment with self-reported recent back pain at follow-up (N = 53,933). RESULTS Recent back pain was self-reported by 8379 (15.5%) participants at follow-up. After adjusting for covariates, deployers with combat experiences had higher odds [odds ratio (OR) = 1.38, 95% confidence interval (95% CI): 1.28-1.50] of recent back pain than noncombat deployers. There was no association between recent back pain and nondeployers compared with noncombat deployers. Service support/supply handlers were at an increased odds of reporting recent back pain (OR = 1.11, 95% CI: 1.02-1.21) than functional support/administration occupations. Occupations associated with a physically demanding work environment had a higher risk of back pain. CONCLUSION Deployers with combat experiences were more likely to report back pain postdeployment. This well-defined group of military personnel may potentially benefit from integrated prevention efforts. LEVEL OF EVIDENCE 3.
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Schoneboom BA, Perry SM, Barnhill WK, Giordano NA, Wiltse Nicely KL, Polomano RC. Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health. Nurs Outlook 2016; 64:459-84. [DOI: 10.1016/j.outlook.2016.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
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Monnier A, Djupsjöbacka M, Larsson H, Norman K, Äng BO. Risk factors for back pain in marines; a prospective cohort study. BMC Musculoskelet Disord 2016; 17:319. [PMID: 27474034 PMCID: PMC4966738 DOI: 10.1186/s12891-016-1172-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background It is recognised that back pain (BP) is a debilitating medical problem in the soldier community, which limits operational readiness as well as work ability. As such, identification of risk factors is a necessity for effective preventive actions, but also regarded as important from a safety perspective. The aim of this prospective cohort study was therefore to identify risk factors for back pain and BP limiting work ability in active duty marines within a 6 and 12-month period. Methods Demographic characteristics, health-related factors and occupational exposure information, as gathered from questionnaires, as well as clinical test of movement control among 137 Swedish marines were regressed with multivariable logistic regressions, and strength of associations was presented as odds ratio (OR) with 95 % confidence intervals (CI). BP within 6 and 12 months were used as primary outcomes, whereas BP limiting work ability within 6 and 12 months served as secondary outcomes. Results Previous BP and tall body height (≥1.86 m) emerged as risk factors for back pain within 6 months (OR 2.99, 95 % CI 1.22–7.30; OR 2.81, 95 % CI 1.16– 6.84, respectively), and 12 months (OR 6.75, 95 % CI 2.30–19.80; 2.75, 95 % CI 1.21–6.29, respectively). Previous BP was also identified as risk factor for BP limiting work ability within 12 months (OR 6.64, 95 % CI 1.78–24.78), and tall body height emerged as a risk within both six (OR 4.30, 95 % CI 1.31–14.13) and 12 months (OR 4.55, 95 % CI 1.53–13.57) from baseline. Conclusions Marines with a history of BP are at risk of further BP episodes, which, thus, emphasise the importance of early BP preventive actions. Tall body height also emerged as an important risk which may reflect that personal equipment and work tasks are not adapted for the tallest marines. While this should be considered when introducing new work equipment, further studies are warranted to clarify the underlying mechanism of this association. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1172-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Monnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. .,Swedish Armed Forces, Regional Medical Service Mälardalen, Berga, Sweden.
| | - Mats Djupsjöbacka
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Swedish Armed Forces, Headquarters, Medical Services, Stockholm, Sweden
| | - Kjell Norman
- Swedish Armed Forces, 1st Marine Regiment, 2nd Amphibious Battalion, Berga, Sweden
| | - Björn O Äng
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Centre for Clinical Research Dalarna, Falun, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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Lenton G, Aisbett B, Neesham-Smith D, Carvajal A, Netto K. The effects of military body armour on trunk and hip kinematics during performance of manual handling tasks (.). ERGONOMICS 2016; 59:806-812. [PMID: 26400048 DOI: 10.1080/00140139.2015.1092589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
Musculoskeletal injuries are reported as burdening the military. An identified risk factor for injury is carrying heavy loads; however, soldiers are also required to wear their load as body armour. To investigate the effects of body armour on trunk and hip kinematics during military-specific manual handling tasks, 16 males completed 3 tasks while wearing each of 4 body armour conditions plus a control. Three-dimensional motion analysis captured and quantified all kinematic data. Average trunk flexion for the weightiest armour type was higher compared with control during the carry component of the ammunition box lift (p < 0.001) and sandbag lift tasks (p < 0.001). Trunk rotation ROM was lower for all armour types compared with control during the ammunition box place component (p < 0.001). The altered kinematics with body armour occurred independent of armour design. In order to optimise armour design, manufacturers need to work with end-users to explore how armour configurations interact with range of personal and situational factors in operationally relevant environments. Practitioner Summary: Musculoskeletal injuries are reported as burdening the military and may relate to body armour wear. Body armour increased trunk flexion and reduced trunk rotation during military-specific lifting and carrying tasks. The altered kinematics may contribute to injury risk, but more research is required.
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Affiliation(s)
- Gavin Lenton
- a Center for Musculoskeletal Research , Griffith Health Institute, Griffith University , Southport , Australia
| | - Brad Aisbett
- b Center for Physical Activity and Nutrition Research , Deakin University , Burwood , Australia
| | - Daniel Neesham-Smith
- c Center for Exercise and Sports Science , Deakin University , Burwood , Australia
| | | | - Kevin Netto
- e School of Physiotherapy and Exercise Science , Curtin University , Bentley , Australia
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Epidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review. Curr Opin Anaesthesiol 2016; 26:562-72. [PMID: 23787490 DOI: 10.1097/aco.0b013e3283628e87] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Epidural steroid injections (ESIs) are the most commonly performed intervention in pain clinics across the USA and worldwide. In light of the growing use of ESIs, a recent spate of highly publicized infectious complications, and increasing emphasis on cost-effectiveness, the utility of ESI has recently come under intense scrutiny. This article provides an evidence-based review of ESIs, including the most up-to-date information on patient selection, comparison of techniques, efficacy, and complications. RECENT FINDINGS The data strongly suggest that ESIs can provide short-term relief of radicular symptoms but are less convincing for long-term relief, and mixed regarding cost-effectiveness. Although some assert that transforaminal ESIs are more efficacious than interlaminar ESIs, and that fluoroscopy can improve treatment outcomes, the evidence to support these assertions is limited. SUMMARY The cost-effectiveness of ESI is the subject of great debate, and similar to efficacy, the conclusions one draws appear to be influenced by specialty. Because of the wide disparities regarding indications and utilization, it is likely that indiscriminate use is cost-ineffective, but that judicious use in well-selected patients can decrease healthcare utilization. More research is needed to better refine selection criteria for ESI, and to determine which approach, what dose, and how many injections are optimal.
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Assessment of chiropractic treatment for active duty, U.S. military personnel with low back pain: study protocol for a randomized controlled trial. Trials 2016; 17:70. [PMID: 26857706 PMCID: PMC4746780 DOI: 10.1186/s13063-016-1193-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone. METHODS/DESIGN This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation. DISCUSSION Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability. TRIAL REGISTRATION The trial discussed in this article was registered in ClinicalTrials.gov with the NCT01692275 Date of registration: 6 September 2012.
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Childs JD, Fritz JM, Wu SS, Flynn TW, Wainner RS, Robertson EK, Kim FS, George SZ. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res 2015; 15:150. [PMID: 25880898 PMCID: PMC4393575 DOI: 10.1186/s12913-015-0830-3] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/30/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). METHODS Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. RESULTS 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. CONCLUSIONS The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.
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Affiliation(s)
- John D Childs
- Army Medical Department Center and School, US Army-Baylor University Doctoral Program in Physical Therapy, 3151 Scott Rd., Rm. 2307, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
| | - Julie M Fritz
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Samuel S Wu
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1329 SW 16th St., Rm. 5231, Gainesville, FL, 32610-0177, USA.
| | - Timothy W Flynn
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA.
| | - Robert S Wainner
- EIM School of Physical Therapy, South College, 3904 Lonas Dr, Knoxville, TN, 37909, USA.
| | - Eric K Robertson
- Doctor of Physical Therapy Program, University of Texas at El Paso, 500 W. University Avenue, El Paso, TX, 79968, USA.
| | - Forest S Kim
- US Army Medical Department Center and School, US Army-Baylor MHA/MBA Program, 3599 Winfield Scott Rd., Bldg. 2841, JBSA Fort Sam Houston, San Antonio, TX, 78234-6135, USA.
| | - Steven Z George
- Department of Physical Therapy, Director, Brooks-PHHP Research Collaboration, University of Florida, P.O. Box 100154, Gainesville, FL, 32610-0154, USA.
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Cody JP, Kang DG, Tracey RW, Wagner SC, Rosner MK, Lehman RA. Outcomes following cervical disc arthroplasty: a retrospective review. J Clin Neurosci 2014; 21:1901-4. [PMID: 24996853 DOI: 10.1016/j.jocn.2014.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/04/2014] [Indexed: 11/30/2022]
Abstract
Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty. We performed a retrospective review of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty from August 2008 to August 2012. The clinical outcomes and complications associated with the procedure were evaluated. A total of 219 consecutive patients were included in the review, with an average follow-up of 11.2 (±11.0)months. Relief of pre-operative symptoms was noted in 88.7% of patients, and 92.2% of patients were able to return to full pre-operative activity. There was a low rate of complications related to the anterior cervical approach (3.2% with recurrent laryngeal nerve injury, 8.9% with dysphagia), with no device/implant related complications. Symptomatic cervical radiculopathy is a common problem in both the civilian and active duty military populations and can cause significant disability leading to loss of work and decreased operational readiness. There exist several surgical treatment options for appropriately indicated patients. Based on our findings, cervical disc arthroplasty is a safe and effective treatment for symptomatic cervical radiculopathy and myelopathy, with a low incidence of complications and high rate of symptom relief.
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Affiliation(s)
- John P Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA
| | - Daniel G Kang
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA
| | - Robert W Tracey
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA
| | - Scott C Wagner
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA.
| | - Michael K Rosner
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA; Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.
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Abstract
STUDY DESIGN Feasibility study on the acquisition of lumbar spine kinematic data from upright magnetic resonance images obtained under heavy load carrying conditions. OBJECTIVE To characterize the effect of the load on spinal kinematics of active Marines under typical load carrying conditions from a macroscopic and lumbar-level approach in active-duty US Marines. SUMMARY OF BACKGROUND DATA Military personnel carry heavy loads of up to 68 kg depending on duty position and nature of the mission or training; these loads are in excess of the recommended assault loads. Performance and injury associated with load carriage have been studied; however, knowledge of lumbar spine kinematic changes is still not incorporated into training. These data would provide guidance for setting load and duration limits and a tool to investigate the potential contribution of heavy load carrying on lumbar spine pathologies. METHODS Sagittal T2 magnetic resonance images of the lumbar spine were acquired on a 0.6-T upright magnetic resonance imaging scanner for 10 active-duty Marines. Each Marine was scanned without load (UN1), immediately after donning load (LO2), after 45 minutes of standing (LO3) and walking (LO4) with load, and after 45 minutes of side-lying recovery (UN5). Custom-made software was used to measure whole spine angles, intervertebral angles, and regional disc heights (L1-S1). Repeated measurements analysis of variance and post hoc Sidak tests were used to identify significant differences between tasks (α = 0.05). RESULTS The position of the spine was significantly (P < 0.0001) more horizontal relative to the external reference frame and lordosis was reduced during all tasks with load. Superior levels became more lordotic, whereas inferior levels became more kyphotic. Heavy load induced lumbar spine flexion and only anterior disc and posterior intervertebral disc height changes were observed. All kinematic variables returned to baseline levels after 45 minutes of side-lying recovery. CONCLUSION Superior and inferior lumbar levels showed different kinematic behaviors under heavy load carrying conditions. These findings suggest a postural, lumbar flexion strategy aimed at centralizing a heavy posterior load over the base of support.
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Marching home, again: spine casualties, combat exposure, and the long wars. Spine J 2012; 12:723-6. [PMID: 23036141 DOI: 10.1016/j.spinee.2012.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 02/03/2023]
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