Back Pain During War

Cohen, Steven P.; Nguyen, Conner; Kapoor, Shruti; Anderson-Barnes, Victoria C.; Foster, Lisa; Shields, Cynthia H.; McLean, Brian; Wichman, Todd; Plunkett, Anthony

doi:10.1001/archinternmed.2009.380

Cited by 58 publications

(19 citation statements)

References 29 publications

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“…Lifestyle intervention with weight reduction has been shown to be a feasible and low-cost treatment for the vast majority of patients with mild OSA [81]. In recent clinical trials, the use of an intensive lifestyle approach, bariatric surgery, and medications to achieve weight loss significantly improved OSA among obese participants [82,83▪,84,85]. …”

Section: Obesity-related Complications and Weight Loss Therapymentioning

confidence: 99%

A complications-based clinical staging of obesity to guide treatment modality and intensity

Daniel

Soleymani

Garvey

2013

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The current medical model for obesity management is BMI-centric because BMI is the predominant measure used to gauge disease severity, as well as indications for various treatment modalities. Recent advancements in therapy and understanding of the relationship between BMI and obesity-related complications call for a re-examination of this approach. Recent findings Advancements in treatment, including the recent approval of two new weight loss medications in the USA, have enabled development of new medical models for management of obesity. On the basis of accumulating data demonstrating the benefits of weight loss regarding multiple obesity-related complications (e.g., diabetes prevention, type 2 diabetes mellitus, cardiovascular disease risk, nonalcoholic steatohepatitis, sleep apnea), a complications-centric model is proposed that employs weight loss as a tool to treat and prevent obesity comorbidities. This model assures that the aggressiveness of therapy is commensurate with disease severity, and that therapy is directed at those obese patients who will benefit most from weight loss therapy. The treatment algorithm is comprehensive in addressing complications and quantitative when possible in the staging of risk or disease severity. Summary A complications-centric approach to obesity management identifies patients who will benefit most from weight loss, and optimizes patient outcomes, benefit/risk ratio, and the cost–effectiveness of interventions.

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Section: Obesity-related Complications and Weight Loss Therapymentioning

confidence: 99%

A complications-based clinical staging of obesity to guide treatment modality and intensity

Daniel

Soleymani

Garvey

2013

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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“…In military populations musculoskeletal pain has an adverse effect by frequently causing medical evacuation [4] and LBP in particular a common reason for long term disability [5]. As a result of its negative impact prevention of LBP has remained a research priority for both general [6] and military populations [4], [7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort

et al. 2012

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Primary prevention studies suggest that additional research on identifying risk factors predictive of low back pain (LBP) is necessary before additional interventions can be developed. In the current study we assembled a large military cohort that was initially free of LBP and followed over 2 years. The purposes of this study were to identify baseline variables from demographic, socioeconomic, general health, and psychological domains that were predictive of a) occurrence; b) time; and c) severity for first episode of self-reported LBP. Baseline and outcome measures were collected via web-based surveillance system or phone to capture monthly information over 2 years. The assembled cohort consisted of 1230 Soldiers who provided self-report data with 518 (42.1%) reporting at least one episode of LBP over 2 years. Multivariate logistic regression analysis indicated that gender, active duty status, mental and physical health scores were significant predictors of LBP. Cox regression revealed that the time to first episode of LBP was significantly shorter for Soldiers that were female, active duty, reported previous injury, and had increased BMI. Multivariate linear regression analysis investigated severity of the first episode by identifying baseline predictors of pain intensity, disability, and psychological distress. Education level and physical fitness were consistent predictors of pain intensity, while gender, smoking status, and previous injury status were predictors of disability. Gender, smoking status, physical health scores, and beliefs of back pain were consistent predictors of psychological distress. These results provide additional data to confirm the multi-factorial nature of LBP and suggest future preventative interventions focus on multi-modal approaches that target modifiable risk factors specific to the population of interest.

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“…In contrast, a brief psychosocial education program in combination with either of the exercise programs resulted in lower two-year incidence of health care-seeking for LBP. These results have potential importance for primary prevention strategies for Soldiers in the military given the high rates of evacuation due to musculoskeletal pain and injuries that adversely affects Soldier preparation [1,2]. …”

Section: Discussionmentioning

confidence: 99%

“…Musculoskeletal pain, and especially low back pain (LBP), adversely affects military preparedness as common reasons for medical evacuation [1] with return to duty being uncertain [1,2]. Furthermore, LBP is also a common reason for long-term Soldier disability [3].…”

Section: Introductionmentioning

confidence: 99%

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Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

George

Childs

Teyhen

et al. 2011

BMC Med

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BackgroundEffective strategies for the primary prevention of low back pain (LBP) remain elusive with few large-scale clinical trials investigating exercise and education approaches. The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise.MethodsThe Prevention of Low Back Pain in the Military study was a cluster randomized clinical study with four intervention arms and a two-year follow-up. Participants were recruited from a military training setting from 2007 to 2008. Soldiers in 20 consecutive companies were considered for eligibility (n = 7,616). Of those, 1,741 were ineligible and 1,550 were eligible but refused participation. For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years (SD = 4.2) and there were 3,082 males (71.3%). Companies were randomly assigned to receive traditional lumbar exercise, traditional lumbar exercise with psychosocial education, core stabilization exercise, or core stabilization with psychosocial education, The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks. The primary outcome for this trial was incidence of low back pain resulting in the seeking of health care.ResultsThere were no adverse events reported. Evaluable patient analysis (4,147/4,325 provided data) indicated no differences in low back incidence resulting in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs. However, brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach, resulting in a 3.3% (95% CI: 1.1 to 5.5%) decrease over two years (numbers needed to treat (NNT) = 30.3, 95% CI = 18.2 to 90.9).ConclusionsCore stabilization has been advocated as preventative, but offered no such benefit when compared to traditional lumbar exercise in this trial. Instead, a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain resulting in the seeking of health care. Since this trial was conducted in a military setting, future studies are necessary to determine if these findings can be translated into civilian populations.Trial RegistrationNCT00373009 at ClinicalTrials.gov - http://clinicaltrials.gov/

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Back Pain During War

Cited by 58 publications

References 29 publications

A complications-based clinical staging of obesity to guide treatment modality and intensity

A complications-based clinical staging of obesity to guide treatment modality and intensity

Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort

Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

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