Home-based approaches for subacute low back pain in AD: Randomized control trial
Name: Laura Talbot
Rank: Col (ret)
Organization: The University of Tennessee Health Science Center
Performance Site: The University of Tennessee Health Science Center; Blanchfield Army Community Hospital, Ft. Campbell
Year Published: 2017
Low back pain is on the increase in the military, and poses a threat to warfighter performance and operational readiness. The number of ambulatory care visits of low back pain (LBP) has shown a striking increase of >62% over the last 5 years in all military services, affecting work performance, limiting activity, and impacting military deployment health. This increase reflects current high operation tempo and frequent deployments of military including demanding training, military operations, and combat injuries. Approximately 80% of acute LBP events will improve within 2-4 weeks, however, a substantial number progress to the persistent, chronic state (LBP >12 weeks) which is resistant to treatment and interferes with military performance. Currently, no evidence-based treatment guidelines exist for the management of subacute LBP (3-12 weeks). Treatments for LBP during the subacute period need further investigation. We have shown that home-based neuromuscular electrical stimulation (NMES) is safe, portable, easy-to-use and improves muscle strength with some pain relief. Evidence suggests that progressive exercise improves patient outcomes in subacute LBP. The use of pain-relieving modalities via primary care management (PCM) combined with muscle strengthening, such as home-based electrotherapy or progressive exercise plan (PEP), could reduce pain, increase strength and improve function more rapidly during the subacute phase of persistent LBP. The proposed study therefore will compare the effects of both NMES and PEP to the standard PCM for service members with subacute LBP. The overall objective of this project is to compare three home-managed treatment regimens for subacute low back pain: Progressive Exercise Plan (PEP), NMES core strength training and standard primary care management (PCM). Our central hypothesis is that the NMES core strength training alone and PEP alone will show significantly greater improvements in muscle strength, pain, mobility/function, daily activity and quality of life (QOL) than PCM alone in military members with low back pain lasting three to twelve weeks. The rationale for this study is that increasing torso muscle strength and decreasing pain through strength training exercises will significantly improve mobility, physical activity, QOL and reduce disability. Such outcomes will ultimately result in improved deployability, retention of military personnel and decreased economic costs in this population. The specific aims will be to determine whether the two treatment régimes are significantly more efficacious than standard PCM alone in improving lower back muscle strength, daily physical activity, physical function quality of life and symptoms associated with subacute LBP. After consent and baseline testing, we will randomly assign active duty male and female subjects, ages 18 to <45, (n=135) with LBP to one of the three groups. Each of the two treatment arms will be supplemented by PCM and compared to a group receiving standard PCM alone. All groups will receive 9 weeks of home therapy. Using longitudinal mixed regression models, we will examine differences in time trends for the outcome variables among controls and those in the treatment groups. In these regression analyses, the important primary measures will be expressed as a function of time, treatment group, and group-by-time interactions, while controlling for important covariates. Positive results could translate into accelerated rehabilitation, decreased symptoms and lower medical costs with better patient outcomes.Relevance: The increased rate of LBP reflects the physical demands of military service, including demanding training programs, maintaining physical fitness and activities associated with military operations. Home therapies of NMES and PEP for subacute LBP are safe, novel and military-relevant and could contribute to evidence-based self-managed approaches that translate into proven treatment options in the theatre of operation.