Functional Restoration and Integrative Therapies in Service Members With Neuromusculoskeletal Injury



Status:Recruiting
Conditions:Chronic Pain, Chronic Pain
Therapuetic Areas:Musculoskeletal
Healthy:No
Age Range:18 - 70
Updated:7/25/2018
Start Date:June 15, 2018
End Date:June 4, 2022
Contact:Linda Eaton
Email:lineaton@uw.edu
Phone:206-616-9396

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Determinants of the Optimal Dose and Sequence of Functional Restoration and Integrative Therapies in Service Members With Neuromusculoskeletal Injury

This study will (1) compare the effectiveness of standard rehabilitative pain care with
complementary and integrative pain therapies; (2) identify subgroups of patients who do and
do not respond to the intervention(s); (3) determine the most effective sequencing of the
interventions; and (4) determine factors associated with treatment response that can be
implemented to support clinical decision-making.

Objectives and Rationale. Pain due to neuromusculoskeletal injuries is a leading cause of
disability among active duty military Service members. The injury rate is significant with
628 neuromusculoskeletal injuries per 1000 person-years among active duty military Service
members. Neuromusculoskeletal injuries include amputations following battlefield trauma,
repetitive motion injuries related to equipment use or weight-bearing postures, and even
injuries or strains incurred during off-duty pursuits. Regardless of cause, the effects on
both individual Service members and military readiness are significant: Only 13% of Service
members being treated primarily for pain ever return to the field.

The Department of Defense (DoD) has recently expanded its capacity to provide both functional
restoration (FR) and complementary and integrative medicine (CIM) therapies for
neuromusculoskeletal injury, pain, and disability. The proposed research aims to determine
the most effective treatment combination, sequence, and duration of standard rehabilitative
care (SRC), such as physical and occupational therapy in combination with cognitive
behavioral therapy and CIM therapies, such as acupuncture and chiropractic, for Service
members preparing to enroll in an intensive FR program that is currently the DoD-recommended
treatment. In addition, this study aims to identify ways to predict in advance which patients
will respond best to which therapeutic regimens.

Potential Impact. This research has the potential to determine which patients are most likely
to benefit from the non-medication pain therapies currently available in all Army
Interdisciplinary Pain Management Centers (IPMC) and how these therapies can most effectively
be combined to achieve the greatest improvements in pain impact, quality of life and ability
to return to duty following injury.

Patients Who Will Benefit. This study will involve active duty Service members referred to an
Army IPMC. The results will be shared with other Military Health System (MHS) and Veterans
Health Administration (VHA) pain management centers so that active duty Service members and
veterans across United States may benefit from a treatment approach that is tailored to their
individual characteristics. It is anticipated that the knowledge gained through this research
will be applicable to family members of Service members and veterans and will ultimately lead
to expansion of TRICARE benefits to include CIM therapies.

Potential Clinical Applications, Benefits, and Risks. This research will assist providers in
determining when to refer their patients with neuromusculoskeletal pain for SRC and/or CIM
therapies prior to FR. It will assist IPMCs in developing treatment plans tailored to the
needs of each patient. Service members and veterans will benefit by being referred for these
approaches when appropriate during the course of disabling chronic pain conditions.
Ultimately, it is hoped that decision tools can be imbedded in the electronic medical record
to guide health care providers to consider referral for these therapies in patients who may
benefit. This study will advance our ability to effectively tailor therapies for
rehabilitation from neuromusculoskeletal pain for different patients to yield the greatest
benefit in physical function and quality of life. The risks of these interventions are
minimal; Service members may experience general muscle soreness for the first week or so of
increased physical activity, but this typically resolves.

Projected Timeline. This research will determine the optimal combination, sequence, and
duration of therapies. It is expected that some active duty Service members could see
improvements in function and quality of life within three weeks, but others may require up to
six weeks to experience meaningful improvement.

Benefit to Military Personnel. This research will benefit Service members experiencing pain
due to neuromusculoskeletal injury. It will identify ways to direct them to the therapies
most likely to yield meaningful improvements in function and quality of life, and thus
facilitate their return to duty. The recommendations from this study will be shared with pain
management centers throughout the DoD, VHA; and, we hope, eventually to TRICARE members.

Inclusion Criteria:

- Active duty service members

- Neuromusculoskeletal or neuropathic pain ≥ 3-months duration

- Pain of sufficient severity to bring about dysfunction in daily social, vocational,
and/or interpersonal activities

Exclusion Criteria:

- Major surgeries within past 6 months or planned within next 6 months

- Unstable psychological disorders

- Active substance use disorder
We found this trial at
1
site
9040 Jackson Ave
Tacoma, Washington 98431
(253) 968-1110
Phone: 206-616-0927
Madigan Army Medical Center Located on Joint Base Lewis-McChord, Madigan Army Medical Center comprises a...
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mi
from
Tacoma, WA
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