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Snow T, Burke L, Sanford DC, Mathew A, Steffen AD, Flynn DM, Doorenbos AZ. Use of a treadmill, lift, and carry battery as a composite functional performance test: analysis of data from a pragmatic randomized controlled trial in a military population participating in a functional restoration program. Physiother Theory Pract 2024; 40:647-657. [PMID: 36282735 PMCID: PMC10126206 DOI: 10.1080/09593985.2022.2135149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The treadmill, lift, and carry (TLC) battery is a composite functional performance test created to measure the effectiveness of a functional restoration (FR) program in a military population. PURPOSE To determine the validity, reliability, and minimal clinically important differences (MCIDs) of the individual tests and the composite TLC battery. METHODS We assessed the validity by mean differences, effect sizes, and standardized response means pre- and post-FR; and by correlations between the TLC battery and other established measures. We assessed reliability by correlating pre- and post-FR scores. We used principal component analysis (PCA) to create a composite measure. We determined MCIDs via distribution methods and receiver operator curve analysis. RESULTS There were significant (p < .001) mean changes and large effect sizes (0.6-0.8) pre- to post-FR. Pre- and posttest Spearman's correlations ranged from 0.5 to 0.6. Spearman's correlations between TLC battery scores and other measures were small (± 0.3-0.4) and significant (p < .001). PCA supported use of a single-component composite. MCIDs were treadmill time: 3 minutes; metabolic equivalent of task: 1.5 units; floor-to-waist lift: 15 lbs; waist-to-shoulder lift: 10 lbs; 40-foot carry: 10 lbs; and composite score: 6 units. CONCLUSION This secondary data analysis provides preliminary support for the validity and reliability of the TLC battery for use in military populations.
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Affiliation(s)
- Tyler Snow
- Department of Rehabilitative Medicine, Madigan Army Medical Center, 9040 Jackson Ave. Tacoma, WA, 98431 USA
| | - Larisa Burke
- College of Nursing, University of Illinois Chicago, 845 S. Damen Ave. Chicago, IL, 60612 USA
| | - Dana C. Sanford
- Department of Rehabilitative Medicine, Madigan Army Medical Center, 9040 Jackson Ave. Tacoma, WA, 98431 USA
| | - Asha Mathew
- College of Nursing, University of Illinois Chicago, 845 S. Damen Ave. Chicago, IL, 60612 USA
| | - Alana D. Steffen
- College of Nursing, University of Illinois Chicago, 845 S. Damen Ave. Chicago, IL, 60612 USA
| | - Diane M. Flynn
- Department of Rehabilitative Medicine, Madigan Army Medical Center, 9040 Jackson Ave. Tacoma, WA, 98431 USA
| | - Ardith Z. Doorenbos
- College of Nursing, University of Illinois Chicago, 845 S. Damen Ave. Chicago, IL, 60612 USA
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St. Seattle, WA, USA
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Flynn DM, Burke LA, Ransom JC, McQuinn HM, Steffen AD, Snow TJ, Doorenbos AZ. Predictors of Sustained Response to Functional Restoration in a Military Population. Mil Med 2023; 188:20-33. [PMID: 37948256 PMCID: PMC10637275 DOI: 10.1093/milmed/usac432] [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: 08/23/2022] [Revised: 11/23/2022] [Accepted: 12/29/2022] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The purpose of this study was to determine if improvement in pain impact and functional performance following a functional restoration (FR) program was sustained up to 6 months posttreatment and to identify predictors of sustained improvement. MATERIALS AND METHODS Secondary analysis of data collected during randomized clinical trial. Study population included 108 US active duty service members who completed an FR program, as well as 3- and/or 6-month follow-up assessments. Primary outcome measure was the NIH Research Task Force (pain) impact score (PIS). Secondary outcome was a composite functional performance measure of treadmill, lifting, and carrying tolerances. Variables analyzed to determine their predictive value included demographics; treatment hours; measures of pain intensity, function, mood, sleep, social satisfaction, pain catastrophizing, kinesiophobia, self-efficacy, pain acceptance, patient activation, functional performance, and neuropathic pain. RESULTS Mean PIS and functional performance improved significantly immediately following FR, but after 6 months, only improvement in functional performance sustained. Responder analysis showed that 6 months after FR, 42% of participants reported improvement that exceeded the minimal clinically important difference in PIS or functional performance. Predictors of sustained PIS improvement included younger age, absence of neuropathic pain features, less self-rated disability, better baseline functional performance, and worse baseline PIS. Predictors of sustained functional performance improvement included more treatment hours, lower baseline pain catastrophizing, and lower baseline functional performance. CONCLUSIONS This study supports the investment of treatment time in FR to yield sustained clinically meaningful improvement, as observed in over 40% of this study's military participants. Pretreatment predictors of sustained response included lower pain catastrophizing and absence of neuropathic pain. Further research is needed to determine if treatments that improve pain catastrophizing and neuropathic pain will result in sustained improvement in pain impact and functional performance following FR program participation.
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Affiliation(s)
- Diane M Flynn
- Physical Performance Service Line, Pain Management Division, Madigan Army Medical Center, Tacoma, DC 90431, USA
| | - Larisa A Burke
- College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jeffrey C Ransom
- Physical Performance Service Line, Pain Management Division, Madigan Army Medical Center, Tacoma, DC 90431, USA
| | - Honor M McQuinn
- Physical Performance Service Line, Pain Management Division, Madigan Army Medical Center, Tacoma, DC 90431, USA
| | - Alana D Steffen
- College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Tyler J Snow
- Physical Performance Service Line, Pain Management Division, Madigan Army Medical Center, Tacoma, DC 90431, USA
| | - Ardith Z Doorenbos
- College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, DC 98105, USA
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Espejo EP, Sheridan TM, Pino CA, Phillips CR. Mental Health Predictors of Response to Standard Medical Intervention at a Military Pain Specialty Clinic. Mil Med 2023; 188:149-156. [PMID: 37948258 DOI: 10.1093/milmed/usad060] [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: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain among active duty service members can negatively impact operational readiness and contributes to significant health care costs within military treatment facilities. Response to standard medical intervention (SMI) for chronic pain is highly variable. The objective of the current study was to examine whether mental health indicators predict individual variation in response to SMI for chronic pain in a military pain specialty clinic. METHODS This is a retrospective observational study of data previously collected at the Pain Medicine Center at Naval Medical Center San Diego (NMCSD) approved by the NMCSD Institutional Review Board. We included 286 ADSMs who completed the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) at two assessment points (mean = 118.45 days apart, SD = 37.22) as part of standard care. Hierarchical linear regression analyses were conducted to examine whether pretreatment mental health measures predict changes in the pain impact score (PIS)-a composite measure of pain intensity, pain interference, and physical functioning-over the course of treatment. RESULTS After controlling for pretreatment PIS, pretreatment PTSD symptoms, fatigue, and anger were all significant predictors of posttreatment PIS: Higher PTSD symptoms, higher fatigue, and lower anger predicted poorer response to treatment (all Ps < .05). CONCLUSION Higher pretreatment PTSD and fatigue symptoms may portend poorer response to SMI for chronic pain. Poor response to treatment may also be predicted by lower pretreatment anger. Further investigation is warranted to identify the best strategies for treating chronic pain in military treatment facilities when these conditions are identified during initial evaluation.
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Affiliation(s)
- Emmanuel P Espejo
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Tara M Sheridan
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Carlos A Pino
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Christopher R Phillips
- Pain Medicine Center, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Highland KB, Kent M, McNiffe N, Patzkowski JC, Patzkowski MS, Kane A, Giordano NA. Longitudinal Predictors of PROMIS Satisfaction With Social Roles and Activities After Shoulder and Knee Sports Orthopaedic Surgery in United States Military Servicemembers: An Observational Study. Orthop J Sports Med 2023; 11:23259671231184834. [PMID: 37529526 PMCID: PMC10387780 DOI: 10.1177/23259671231184834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/11/2023] [Indexed: 08/03/2023] Open
Abstract
Background Satisfaction with social roles and activities is an important outcome for postsurgical rehabilitation and quality of life but not commonly assessed. Purpose To evaluate longitudinal patterns of the Patient-Reported Outcomes Measurement Information System (PROMIS) Satisfaction with Social Roles and Activities measure, including how it relates to other biopsychosocial factors, before and up to 6 months after sports-related orthopaedic surgery. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Participants (N = 223) who underwent knee and shoulder sports orthopaedic surgeries between August 2016 and October 2020 completed PROMIS computer-adaptive testing item banks and pain-related measures before surgery and at 6-week, 3-month, and 6-month follow-ups. In a generalized additive mixed model, covariates included time point; peripheral nerve block; the PROMIS Anxiety, Sleep Disturbance, and Pain Behavior measures; and previous 24-hour pain intensity. Patient-reported outcomes were modeled as nonlinear (smoothed) effects. Results The linear (estimate, 2.06; 95% CI, 0.77-3.35; P = .002) and quadratic (estimate, 2.93; 95% CI, 1.78-4.08; P < .001) effects of time, as well the nonlinear effects of PROMIS Anxiety (P < .001), PROMIS Sleep Disturbance (P < .001), PROMIS Pain Behavior (P < .001), and pain intensity (P = .02), were significantly associated with PROMIS Satisfaction with Social Roles and Activities. The cubic effect of time (P = .06) and peripheral nerve block (P = .28) were not. The proportion of patients with a 0.5-SD improvement in the primary outcome increased from 23% at 6 weeks to 52% by 6 months postsurgery, whereas those reporting worsening PROMIS Satisfaction with Social Roles and Activities decreased from 30% at 6 weeks to 13% at 6 months. Conclusion The PROMIS Satisfaction with Social Roles and Activities measure was found to be related to additional domains of function (eg, mental health, behavioral, pain) associated with postsurgical rehabilitation.
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Affiliation(s)
- Krista B. Highland
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA
| | - Michael Kent
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas McNiffe
- School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jeanne C. Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Michael S. Patzkowski
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA
- Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Alexandra Kane
- Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Nicholas A. Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Eaton LH, Flynn DM, Steffen AD, Doorenbos AZ. The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military. Pain Manag Nurs 2023; 24:123-129. [PMID: 36653221 PMCID: PMC10106383 DOI: 10.1016/j.pmn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Chronic pain treatment in the military includes complementary and integrative health (CIH) therapies that may affect psychological factors such as pain catastrophizing, chronic pain acceptance, pain self-efficacy, and patient activation. The unique roles that psychosocial factors play in how CIH approaches reduce pain are not clear. This study examined if a holistic pain management program improved pain outcomes through psychological mediators in service members with chronic pain. DESIGN Secondary analysis of a clinical trial. METHODS Active-duty service members (n = 210) were randomly assigned to a 3-week course of standard rehabilitative care or standard rehabilitative care combined with CIH therapies. Both treatments were followed by a 3-week functional restoration program. Study measures were completed pre- and post-treatment using the Military Health System's Pain Assessment Screening Tool and Outcomes Registry. Mediation analyses tested the indirect effects of the change in psychological factors before functional restoration on the change in pain impact (e.g., pain intensity, pain interference, functional status) after functional restoration. RESULTS All psychological factors except for chronic pain acceptance were related to improved pain impact (p<.05). Furthermore, a change in psychological factors prior to functional restoration was related to the change in pain impact after functional restoration. However, the addition of CIH therapies to standard rehabilitative care did not result in changes in pain outcomes mediated by the psychological factors. CONCLUSIONS Although psychological factors were related to pain outcomes, the effect of CIH therapies on chronic pain did not occur via a change in the four psychological factors.
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Affiliation(s)
- Linda H Eaton
- University of Washington Bothell, School of Nursing and Health Studies, Bothell, Washington
| | - Diane M Flynn
- Interdisciplinary Pain Management Center, Madigan Army Medical Center, Tacoma, Washington.
| | - Alana D Steffen
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois.
| | - Ardith Z Doorenbos
- University of Illinois at Chicago, College of Nursing, Chicago, Illinois; University of Washington, Anesthesiology and Pain Medicine, Seattle, Washington.
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Assessment from a Biopsychosocial Approach of Flight-Related Neck Pain in Fighter Pilots of Spanish Air Force. An Observational Study. Diagnostics (Basel) 2022; 12:diagnostics12020233. [PMID: 35204324 PMCID: PMC8870975 DOI: 10.3390/diagnostics12020233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Flying on fighter aircraft is the only human activity that exposes the body to acceleration levels for long periods of time. In this sense, the regular exposure to G forces has been related to a high incidence of flight-related neck pain. The aim is to evaluate flight pilots of the Spanish Air Force (instructors vs. students) diagnosed with flight-related neck pain from a biopsychosocial perspective. Eighteen fighter pilots with flight-related neck pain were divided into two groups: instructor fighter pilots (n = 7) and student fighter pilots (n = 11). The Neck Disability Index (NDI), Cervical Range of Motion (CRoM), Pain Pressure Threshold (PPT), cervical repositioning error, and myoelectric activity were evaluated. Cervical flexion, extension and left and right rotation showed a reduced range of motion in both groups with respect to the normative values of the healthy population. There were no statistically significant differences between the groups (p ≥ 05). The correlational analysis showed a strong association between the NDI and CRoM of the left rotation (β = −0.880, p = 0.002). The NDI also had a positive association with the pilot’s age (β = 1.353, p < 0.01) and the number of flight hours (β = 0.805, p = 0.003). In conclusion, the Cervical Range of Motion at the left rotation seems to determine the perceived degree of disability in both the instructors and students. This factor could be influenced by the number of flight hours and accumulated experience as an F-5 fighter pilot.
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