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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 Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mauntel TC, Tenan MS, Freedman BA, Potter BK, Provencher MT, Tokish JM, Lee IE, Rhon DI, Bailey JR, Burns TC, Cameron KL, Grenier ES, Haley CA, Leclere LE, McDonald LS, Owens BD, Pallis MP, Posner MA, Rivera JC, Roach CJ, Robins RJ, Schmitz MR, Sheean AJ, Slabaugh MA, Volk WR, Dickens JF. The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System. Mil Med 2020; 187:e282-e289. [DOI: 10.1093/milmed/usaa304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/29/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022] Open
Abstract
Abstract
Introduction
Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense’s Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care.
Materials and Methods
MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management.
Results
This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report.
Conclusions
MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency’s Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.
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Affiliation(s)
- Timothy C Mauntel
- DoD-VA Extremity Trauma and Amuptation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | | | | | - Benjamin K Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
| | - Matthew T Provencher
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
- The Steadman Clinic and Philippon Research Institute, Vail, CO 81657
| | | | - Ian E Lee
- Defense Health Agency, Falls Church, VA 22042
| | - Daniel I Rhon
- US Army Office of the Surgeon General, Falls Church, VA 22042
| | | | | | | | | | | | | | | | - Brett D Owens
- University Orthopaedics, East Providence, RI 02914
- Department of Orthopaedic Surgery, Brown University, Providence, RI 02914
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - Mark P Pallis
- Geisinger Musculoskeletal Institute, Wilkes Barre, PA 18702
| | | | - Jessica C Rivera
- Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | | | - Richard J Robins
- Department of Orthopaedics, United States Air Force Academy, US Air Force Academy, CO 80840
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | | | | | - Mark A Slabaugh
- Department of Orthopaedics, United States Air Force Academy, US Air Force Academy, CO 80840
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - William R Volk
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889
- Department of Orthopaedics, Keller Army Community Hospital, West Point, NY 10996
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20889
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Molloy JM, Pendergrass TL, Lee IE, Chervak MC, Hauret KG, Rhon DI. Musculoskeletal Injuries and United States Army Readiness Part I: Overview of Injuries and their Strategic Impact. Mil Med 2020; 185:e1461-e1471. [DOI: 10.1093/milmed/usaa027] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/07/2019] [Accepted: 01/29/2020] [Indexed: 12/25/2022] Open
Abstract
Abstract
Introduction
Noncombat injuries (“injuries”) greatly impact soldier health and United States (U.S.) Army readiness; they are the leading cause of outpatient medical encounters (more than two million annually) among active component (AC) soldiers. Noncombat musculoskeletal injuries (“MSKIs”) may account for nearly 60% of soldiers’ limited duty days and 65% of soldiers who cannot deploy for medical reasons. Injuries primarily affect readiness through increased limited duty days, decreased deployability rates, and increased medical separation rates. MSKIs are also responsible for exorbitant medical costs to the U.S. government, including service-connected disability compensation. A significant subset of soldiers develops chronic pain or long-term disability after injury; this may increase their risk for chronic disease or secondary health deficits potentially associated with MSKIs. The authors will review trends in U.S. Army MSKI rates, summarize MSKI readiness-related impacts, and highlight the importance of standardizing surveillance approaches, including injury definitions used in injury surveillance.
Materials/Methods
This review summarizes current reports and U.S. Department of Defense internal policy documents. MSKIs are defined as musculoskeletal disorders resulting from mechanical energy transfer, including traumatic and overuse injuries, which may cause pain and/or limit function. This review focuses on various U.S. Army populations, based on setting, sex, and age; the review excludes combat or battle injuries.
Results
More than half of all AC soldiers sustained at least one injury (MSKI or non-MSKI) in 2017. Overuse injuries comprise at least 70% of all injuries among AC soldiers. Female soldiers are at greater risk for MSKI than men. Female soldiers’ aerobic and muscular fitness performances are typically lower than men’s performances, which could account for their higher injury rates. Older soldiers are at greater injury risk than younger soldiers. Soldiers in noncombat arms units tend to have higher incidences of reported MSKIs, more limited duty days, and higher rates of limited duty days for chronic MSKIs than soldiers in combat arms units. MSKIs account for 65% of medically nondeployable AC soldiers. At any time, 4% of AC soldiers cannot deploy because of MSKIs. Once deployed, nonbattle injuries accounted for approximately 30% of all medical evacuations, and were the largest category of soldier evacuations from both recent major combat theaters (Iraq and Afghanistan). More than 85% of service members medically evacuated for MSKIs failed to return to the theater. MSKIs factored into (1) nearly 70% of medical disability discharges across the Army from 2011 through 2016 and (2) more than 90% of disability discharges within enlisted soldiers’ first year of service from 2010 to 2015. MSKI-related, service-connected (SC) disabilities account for 44% of all SC disabilities (more than any other body system) among compensated U.S. Global War on Terrorism veterans.
Conclusions
MSKIs significantly impact soldier health and U.S. Army readiness. MSKIs also figure prominently in medical disability discharges and long-term, service-connected disability costs. MSKI patterns and trends vary between trainees and soldiers in operational units and among military occupations and types of operational units. Coordinated injury surveillance efforts are needed to provide standardized metrics and accurately measure temporal changes in injury rates.
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Affiliation(s)
- Joseph M Molloy
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
| | - Timothy L Pendergrass
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
| | - Ian E Lee
- Solution Delivery Division, U.S. Defense Health Agency, Falls Church, VA 22042
| | - Michelle C Chervak
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Keith G Hauret
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Daniel I Rhon
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- U.S. Army Office of the Surgeon General, Physical Performance Service Line, G 3/5/7, Falls Church, VA 22042
- Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, TX 78234
- Duke Clinical Research Institute, Duke University, Durham, NC 27701
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Molloy JM, Pendergrass TL, Lee IE, Hauret KG, Chervak MC, Rhon DI. Musculoskeletal Injuries and United States Army Readiness. Part II: Management Challenges and Risk Mitigation Initiatives. Mil Med 2020; 185:e1472-e1480. [DOI: 10.1093/milmed/usaa028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroductionNoncombat injuries (“injuries”) threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers’ injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army.Materials/MethodsThis review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries.ResultsPrimary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction.Secondary risk reductionForward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability.Tertiary risk reductionOperational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs.ConclusionsStandardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army’s standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army’s electronic physical profiling system further enablesstandardized documentation of MSKI-related duty/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.
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Affiliation(s)
- Joseph M Molloy
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- Physical Performance Service Line, G 3/5/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042
| | - Timothy L Pendergrass
- Physical Performance Service Line, G 3/5/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042
| | - Ian E Lee
- Solution Delivery Division, U.S. Defense Health Agency, Falls Church, VA 22042
| | - Keith G Hauret
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Michelle C Chervak
- U.S. Army Public Health Center, Injury Prevention Program, Aberdeen Proving Ground, Aberdeen, MD 21005
| | - Daniel I Rhon
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
- Physical Performance Service Line, G 3/5/7, U.S. Army Office of the Surgeon General, Falls Church, VA 22042
- Center for the Intrepid, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, San Antonio, TX 78234
- Duke Clinical Research Institute, Duke University, Durham, NC 27701
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Dembowski SC, Tragord BS, Hand AF, Rohena-Quinquilla IR, Lee IE, Thoma DC, Molloy JM. Injury Surveillance and Reporting for Trainees with Bone Stress Injury: Current Practices and Recommendations. Mil Med 2018; 183:e455-e461. [PMID: 29788396 DOI: 10.1093/milmed/usy101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/04/2023] Open
Abstract
Background Musculoskeletal injuries, including lower extremity bone stress injuries (BSI) significantly impact initial entry training (IET) in the U.S. Army due to limited duty days, trainee attrition, early medical discharge, and related financial costs. Factors complicating trainee BSI surveillance include inconsistent BSI coding practices, attrition documentation as both administrative separations and medical discharges and the inability to code for BSI grade or severity when using International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) codes. Methods A multidisciplinary expert panel developed policy guidance to enhance clinical and administrative management of BSI, following extensive analysis of current, peer-reviewed literature. Policy guidance incorporates leading practices concerning clinical BSI management, including imaging procedures, recommended notifications, early intervention, and ICD-10 diagnostic coding procedures. Policy guidance also standardizes BSI grading criteria for magnetic resonance imaging and skeletal scintigraphy (bone scan). Findings Multidisciplinary expert opinion indicates inconsistent BSI diagnosis and management across IET due to variability in trainee BSI grading, documentation, and coding practices. Injury surveillance conducted by the United States Army Medical Command (USAMEDCOM) will benefit from routine, standardized musculoskeletal injury data base searches by BSI severity/grade and anatomical location upon implementation of BSI policy guidance. Discussion Effective injury surveillance is critical for determining trainee BSI incidence and attrition, developing anticipated return to duty (RTD) timelines, and assessing long-term outcomes. BSI RTD timelines should account for gender, BSI grade/severity, anatomical location, and type of intervention. Well-defined RTD timelines would benefit administrative decision-making purposes, including whether to grant convalescent leave or enroll in the Warrior Training and Rehabilitation Program during BSI recovery. Enhanced management procedures may improve initial enlistment completion rates for trainees sustaining at least one BSI who eventually complete IET.
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Affiliation(s)
- Scott C Dembowski
- Department of Physical Therapy, Womack Army Medical Center, Fort Bragg, NC
| | - Bradley S Tragord
- US Army-Baylor University Doctor of Physical Therapy Program, AMEDD Center and School, Joint Base San Antonio, TX
| | - Amy F Hand
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Iván R Rohena-Quinquilla
- Department of Radiology, Martin Army Community Hospital, Fort Benning, GA.,Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Ian E Lee
- Office of the Surgeon General, Medical Command Headquarters Physical Performance Service Line, Falls Church, VA
| | - David C Thoma
- Department of Radiology, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii
| | - Joseph M Molloy
- ORISE Knowledge Preservation Program, Office of the Surgeon General, US Army Medical Command, Physical Performance Service Line, Falls Church, VA
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Rendeiro DG, Deyle GD, Gill NW, Majkowski GR, Lee IE, Jensen DA, Wainner RS. Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial. Physiother Theory Pract 2018; 35:703-723. [PMID: 29658838 DOI: 10.1080/09593985.2018.1457118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC.
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Affiliation(s)
| | - Gail D Deyle
- b Army-Baylor University Doctoral Fellowship Program in Orthopaedic Manual Physical Therapy , Brooke Army Medical Center, Fort Sam Houston , San Antonio, TX , USA
| | - Norman W Gill
- c Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston , San Antonio, TX , USA
| | - Guy R Majkowski
- d US Air Force Health Clinic, United States Air Force, RAF Lakenheath , England
| | - Ian E Lee
- e U.S. Army Office of the Surgeon General , Falls Church , VA , USA
| | - Dale A Jensen
- f Department of Physical Medicine and Rehabilitation , Naval Medical Center Portsmouth , Portsmouth , VA
| | - Robert S Wainner
- g DPT Program, School of Physical Therapy , South College , Knoxville , TN , USA
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Duplessis DH, Greenway EH, Keene KL, Lee IE, Clayton RL, Metzler T, Underwood FB. Effect of semi-rigid lumbosacral orthosis use on oxygen consumption during repetitive stoop and squat lifting. Ergonomics 1998; 41:790-797. [PMID: 9629064 DOI: 10.1080/001401398186649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The use of back belts in industry has increased despite the lack of scientific evidence supporting their efficacy. The purpose of this study was to investigate the effect of a semi-rigid lumbosacral orthosis (SRLSO) on oxygen consumption during 6-min submaximal repetitive lifting bouts of 10 kg at a lifting frequency of 20 repetitions min-1. Fifteen healthy subjects (13 men, two women) participated in this study. Each subject performed squat and stoop lifting with and without an SRLSO for a total of four lifting bouts. Lifting bouts were performed in random order. Oxygen consumption during the final minute of each lifting bout was used for analysis. A two-way analysis of variance with repeated measures was used to analyse the effects of lift and belt conditions. The stoop and squat methods were significantly different, with the squat lift requiring 23% more oxygen on average than the stoop lift for equal bouts of work. No significant difference was found between the belt and no belt condition within the same lifting technique and no interaction was present. These data suggest that an SRLSO does not passively assist the paravertebral muscles (PVM) in stabilizing the spine during submaximal lifting bouts.
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Affiliation(s)
- D H Duplessis
- US Army-Baylor University Graduate Program in Physical Therapy, Medical Science Department, Fort Sam Houston, Texas 78234-6138, USA
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