Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint.

STUDY DESIGN: Randomized clinical trial. PURPOSE: Contribution of the posterior interosseous nerve (PIN) and surrounding skin envelope to wrist proprioception is a topic of debate and the primary focus of this research. METHODS: We performed a double-blinded, placebo control study in which subjects underwent baseline multiplanar testing of wrist proprioception. They were randomized to receive either anesthetic blockade of the PIN within the fourth dorsal compartment, or circumferential topical anesthetic blockade of skin surrounding the wrist. Corresponding opposite wrists underwent placebo intervention with saline injection or inert ultrasound gel. Subjects repeated proprioceptive testing. RESULTS: Eighty subjects, 45 male and 35 female, mean age 33 years (range, 19-64 years), completed testing. The percentage of measurements falling outside a ±18° range did not differ between pre-treatment and post-treatment PIN blockade or for circumferential skin anesthesia. CONCLUSIONS: Wrist proprioception appears to be a multifactorial phenomenon. Surgeons may sacrifice the PIN without concern for effect on joint proprioception. LEVEL OF EVIDENCE: Level I.

Total Force Fitness: Making Holistic, Integrated Whole-Person Research a DoD Priority.

Total Force Fitness (TFF) was conceived as a holistic framework for building and sustaining Human Performance Optimization for Warfighters and their families. As such, TFF research must also be holistic in nature. During the research breakout, group barriers and challenges to TFF research were discussed, and critical research focus areas were prioritized. The top approaches discussed were (1) using big data to identify best practices and health trajectories; (2) applying community-based participatory research principles to military units; (3) focusing on "Whole-Person," integrative research (physical, behavioral, spiritual, and biological) across the Department of Defense; and, finally, (4) prioritizing key opportunities to advance TFF across the active duty and Reserve/Guard enterprises and their families. The research group noted that coordinated action would be needed to move the prioritized agenda forward. Finally, translating research into action is essential because TFF is a way of honoring our service members as whole persons with careers, goals, and families.

The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.

OBJECTIVE: To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. METHODS: A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). RESULTS: The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. CONCLUSION: A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.

Sport Psychology for the Soldier Athlete: A Paradigm Shift.

Background: Competitive athletes train body and mind in preparation for competition with mental fortitude often providing the "winning edge." Similarly, the current-day warfighter faces significant physical and psychological challenges and must be prepared to respond to life-threatening danger with mental and physical agility. Sport Psychology for the Soldier Athlete recognizes the soldier as an elite athlete and provides training required to perform at the highest caliber. Through this curriculum, mental skills coaching in goal setting, imagery, positive self-talk, and heart rate control is integrated into routine physical fitness training. These skills commonly used by professional and Olympic athletes for optimal performance provide soldiers with the ability to manage every day military stressors. Sport Psychology for the Soldier Athlete supports GEN Milley's top priority of readiness and decreases the cost of Army Physical Fitness Test (APFT) failures. Procedures: Soldiers from a large military treatment facility participated in a 6-wk sport psychology mental skills training program led by an Army occupational therapist. The training that was integrated into regularly scheduled physical training consisted of 10 min of physical readiness training, 10 min of mental skills coaching followed by push-up, sit-up, and running drills focusing on the mental skills learned. Semi-annual APFT scores following the sport psychology training were compared with the five previous semi-APFT scores for the same company using analysis of variance. Findings: Results comparing company APFT scores to the previous five semi-annual tests showed statistical significance of 0.001 with the intervention group achieving an average 13- to 14-point improvement. Post-training survey showed 91% of participants recognizing the benefit of these "life skills" in other Army tasks such as weapons qualification, combat medic tasks, and career planning. Soldiers acknowledged this curriculum as quality hands-on training with the suggestion for further development. Discussion: A proactive approach to incorporating mental skills training into the military culture, Sport Psychology for the Soldier Athlete, is in direct alignment with The Army Human Dimension Strategy of developing mental and physical proficiency. This paradigm shift is both timely and necessary for answering readiness and resilience needs of U.S troops and provides additional tools for attaining optimal physical and mental endurance.