Psychological Risk Factors for Delayed Recovery Among Active Duty Service Members Seeking Treatment for Musculoskeletal Complaints at a Navy Shore-Based Military Medical Treatment Facility.

INTRODUCTION: Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. MATERIALS AND METHODS: Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. RESULTS: Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. CONCLUSIONS: A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness.

Musculoskeletal Complaints Among Active Duty Service Members Seeking Treatment at a Navy Military Treatment Facility.

INTRODUCTION: Musculoskeletal injuries (MSIs) pose a significant problem for active duty service members (ADSMs). MSIs may compromise readiness and are one of the main reasons for separation from the Navy and long-term disability. Implementation of optimal treatment strategies rests on understanding the characteristics of MSI complaints in a given population. This study reports on the frequency and nature of MSI complaints of ADSMs seeking care at a military treatment facility (MTF). MATERIALS AND METHODS: As part of a larger quasi-experimental study, data on MSIs from ADSMs reporting to an MTF were collected. Subjects completed a baseline questionnaire during an initial evaluation, including the self-reported MSIs for which participants were seeking care, time since onset, and other MSI comorbidities. RESULTS: Of the 289 respondents, 118 (41%) were female and 172 (59%) were male. The mean age was 33 years (SD = 8). The most frequently reported injury was low-back pain (n = 79, 27%), followed by knee pain (n = 60, 21%) and shoulder pain (n = 55, 19%). Thirty-four (12%) respondents reported injuries to the ankle or foot. The remaining respondents (21%) reported injuries to the neck, mid-back, arm or hand, hip, or other. Sixty-five (22%) reported an acute/subacute injury of less than 3 months, whereas 224 (78%) reported chronic injury >3 months. Furthermore, MSI comorbidities were reported by 233 (80%) of respondents with 128 of those reporting more than one. CONCLUSIONS: Back and knee injuries were most prevalent in ADSMs reporting an MSI at a Navy shore-based MTF. Shoulder injuries were also common. Of interest, 80% of ADSMs reported at least one MSI comorbidity and 80% reported chronic injury in this study. These rates are higher than those found in a previous study of ADSMs deployed on a carrier. This is notable because chronicity and multiple MSIs are obstacles to readiness. Our findings suggest that ADSMs reporting to shore-based facilities may be at higher risk for disability than their deployed counterparts. This information is important to the development of targeted care to improve readiness in this population.

What do older adults want from spine care?

Introduction: Older adults comprise a large portion of back pain (BP) sufferers but are under-represented in the literature. Patients over age 65 present with different clinical characteristics and psychosocial needs than younger patients. Therefore, recommended patient-centered outcomes for BP may not be relevant to older patients. Research question: What treatment outcomes are most important to adults over 65 years of age? Materials and methods: We queried older adults seeking treatment for BP using qualitative methods. Participants were asked about their goals and expectations of treatment in an audio-taped interview. Audiotapes were transcribed, coded and analyzed by the investigators. Using thematic analysis, main themes and constructs were extracted and interpreted by the investigators. From there we were able to generate hypotheses about what older patients want from spine treatment. Results: For all participants, age played a role in their treatment goals as a moderator or motivator. They were most concerned with returning to usual activities and preventing further physical limitations to maintain independence. Goals that reflect important outcomes such as increasing walking tolerance and improving balance were of particular importance. Confidence in the provider acted as a facilitator of goals. Discussion and conclusion: Unlike their younger cohorts, they did not emphasize work-related outcomes and pain relief. These findings can be tested in future quantitative studies and will help to develop protocols for outcomes assessment in older adults. This study is a first step towards understanding and improving the quality of care for older patients with back pain.