j galvin, p rooney, a Egan, j tokish, j grassbaugh, b masini, k free, m bastian, l gillette, z colburn

The purpose of this study was to compare gene expression differences in the blood and tissue of patients with anterior shoulder instability with and without significant glenoid bone loss (GBL). The hypothesis was that the severity of GBL would be associated with the expression level of genes in the blood and capsular tissue of patients with anterior shoulder instability.

Consecutive patients with anterior shoulder instability undergoing arthroscopic and open shoulder stabilization were prospectively enrolled. Blood and anterior capsular tissue specimens obtained during surgery were compared between patients with significant GBL (≥10%) and patients without significant GBL (<10%). RNA was extracted, and a panel of 277 inflammatory genes was utilized to quantify gene expression at the RNA level using a probe-based RNA quantification platform. Differential expression analysis was performed to identify genes expressed at different levels between patients with and without significant GBL. The expression levels of the subset of genes identified were used to generate a ridge regression model to predict the severity of GBL. Quantitative polymerase chain reaction was performed to confirm probe-based RNA findings.

A total of 17 patients were included, with a mean age of 26 years. Overall, 7 patients had <10% GBL (mean, 2.3%), and 10 patients had ≥10% GBL (mean, 16.4%). There were 9 genes that were identified as significantly differentially expressed in the blood, and 5 of these (IFIT1, IFIT3, IFI44, PRKCB, and OAS2 with P values of 1 × 10−5, 1 × 10−4, 1 × 10−4, 1 × 10−4, and 6 × 10−4, respectively) were confirmed using nonparametric tests. The authors developed a model using the 5 genes to predict the severity of GBL, and this had an accuracy of 88% (95% CI, 64%-99%). By quantitative polymerase chain reaction, IFIT3 was confirmed to be significantly differentially expressed (P = .012).

Galvin JW, Rooney P, Egan A, Tokish JM, Grassbaugh JA, Masini B, Free KE, Bastian MK, Gillette LH, Colburn ZT. Transcriptomics of Anterior Shoulder Instability: Differences in Gene Expression in the Blood of Patients With and Without Significant Glenoid Bone Loss. Orthopaedic Journal of Sports Medicine. 2025;13(5). doi:10.1177/23259671251336394

D rhon, s george, n parsons, j fritz

Beliefs can affect perceived harms and benefits of a treatment. The purpose of this study was to assess the relationship between beliefs about exercise and surgery effectiveness and pain interference and physical function in patients with non-specific low back pain. This was a cohort of 629 pooled clinical trial participants receiving non-pharmacological pain management. Participants either agreed (somewhat or completely) or disagreed that surgery would be beneficial or that exercise would make their symptoms worse. Those that agreed were categorized as having high expectations about the treatment. The influence of high expectations on short-term (6-week) and long-term (6-month) PROMIS Pain Interference scores was modeled with generalized linear (Gaussian) models. In a subset of 510 patients, the same analysis was conducted using PROMIS Physical function scores. The cohort was 28.8% female, mean(SD) age of 33.4(8.3) years and 83.1% active-duty. In all 67.1% had low expectations of exercise and 11.0% had high expecations of surgery. High expectations for surgery were not a significant predictor of pain interference or physical function. High expectations for exercise predicted lower pain interference (ß=−2.146, 95CI −3.366, −0.926; P<0.001) and higher physical function (ß=1.807, 95CI 0.586, 3.027; P=0.004) at 6 weeks and 6 months. High expectations for exercise were uncommon (about 33%) but associated with better outcomes out to six months. One in 10 patients had high expectations for surgery but this was not associated with outcomes. A better understanding of treatment expectations may present opportunities to improve engagement and education strategies for patients with low back pain.

Rhon D, George S, Parsons N, Fritz J. Expectations About the Benefit of Exercise, Not Surgery, are Associated with Future Pain and Physical Function in Patients with Non-Specific Low Back Pain. The Journal of Pain, Volume 31. 2025. 1526-5900. https://doi.org/10.1016/j.jpain.2025.105414.

A Sheean, m tenan, M defoor, d cognetti, a bedi, a lin, t dekker, motion collaborative, j dickens

There are multiple methods for calculating the minimal clinically important difference (MCID) threshold, and previous reports highlight heterogeneity and limitations of anchor-based and distribution-based analyses. The Warfighter Readiness Survey assesses the perception of a military population’s fitness to deploy and may be used as a functional index in anchor-based MCID calculations. The purpose of the current study in a physically demanding population undergoing shoulder surgery was to compare the yields of 2 different anchor-based methods of calculating MCID for a battery of PROMs, a standard receiver operating characteristic (ROC) curve–based MCIDs and baseline-adjusted ROC curve MCIDs.

All service members enrolled prospectively in a multicenter database with prior shoulder surgery that completed pre- and postoperative PROMs at a minimum of 12 months were included. The PROM battery included Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Patient Reported Outcome Management Information System (PROMIS) physical function (PF), PROMIS pain interference (PI), and the Warfighter Readiness Survey. Standard anchor-based and baseline-adjusted ROC curve MCIDs were employed to determine if the calculated MCIDs were both statistically and theoretically valid (95% confidence interval [CI] either completely negative or positive).

A total of 117 patients (136 operations) were identified, comprising 83% males with a mean age of 35.7 ± 10.4 years and 47% arthroscopic labral repair/capsulorrhaphy. Using the standard, anchor-based ROC curve MCID calculation, the area under the curve (AUC) for SANE, ASES, PROMIS PF, and PROMIS PI were greater than 0.5 (statistically valid). For ASES, PROMIS PF, and PROMIS PI, the calculated MCID 95% CI all crossed 0 (theoretically invalid). Using the baseline-adjusted ROC curve MCID calculation, the MCID estimates for SANE, ASES, and PROMIS PI were both statistically and theoretically valid if the baseline score was less than 70.5, 69, and 65.7.

When MCIDs were calculated and anchored to the results of standard, anchor-based MCID, a standard ROC curve analysis did not yield statistically or theoretically valid results across a battery of PROMs commonly used to assess outcomes after shoulder surgery in the active duty military population. Conversely, a baseline-adjusted ROC curve method was more effective at discerning changes across a battery of PROMs among the same cohort.

Sheean AJ, Tenan MS, DeFoor MT, Cognetti DJ, Bedi A, Lin A, Dekker TJ; MOTION Collaborative; Dickens JF. Minimal important clinical difference values are not uniformly valid in the active duty military population recovering from shoulder surgery. J Shoulder Elbow Surg. 2024 Nov;33(11):e596-e605. doi: 10.1016/j.jse.2024.02.044. Epub 2024 Apr 16. PMID: 38614369.

E Anies, r Waltz, S lacey

A 49-year-old man presented with repeated episodes of right posterior knee effusions 11 months following right knee medial meniscus debridement. He was referred to Physical Medicine & Rehabilitation (PM&R) by his orthopaedic surgeon for further non-operative management. He had previously undergone ipsilateral vein stripping procedures with vascular surgery 5 months following his meniscal procedure. MRI of the knee with contrast along with a subsequent ultrasound evaluation with no evident power doppler flow confirmed the presence of a right posterior-medial gastrocnemius fluid collection extending extramuscularly into the proximal 1/3rd of the medial head of the gastrocnemius muscle. These imaging findings combined with the yellow-clear aspirate consistent with synovial fluid confirmed the presence of a Baker’s cyst with unusually distal extramuscular extension and subcutaneous location just superficial to the medial head of the gastrocnemius muscle. Successful implementation of platelet rich plasma (PRP) and Doxycycline tissue sclerosis emphasised the key role that nonoperative modalities have in treating Baker’s cysts. The patient continues to respond appropriately with resolution of his symptoms noted 3 weeks after his initial sclerotherapy session and an additional treatment performed with half the initial dose of doxycycline. This case demonstrates the successful treatment of a baker’s cyst with an unusually distal location.

Anies E P, Waltz R A, Lacey S (January 15, 2025) A Baker’s Cyst with Distal Extramuscular Extension: A Case Report. Cureus 17(1): e77502. doi:10.7759/cureus.77502

a weart, l brown, e florkiewics, g fresinger, k east, n reilly, j song, d goss

Background: Running biomechanics have been linked to the development of running-related injuries in recreational and military runners.

Purpose/Hypothesis: The purpose of this study was to determine if personal characteristics or running biomechanical variables are associated with running-related injury incidence or time to injury in military cadets undergoing training. It was hypothesized that a rearfoot strike pattern, greater rate of impact, or a lower step rate would be related to a greater running-related injury incidence and a decreased time to injury.

Study Design: Cohort study; Level of evidence, 2.

Methods: Military cadets wore an on-shoe wearable sensor that analyzed biomechanical variables of foot strike pattern, rate of impact, running pace, step rate, step length, and contact time during cadet basic training (60 days). Running-related injuries during cadet basic training were determined by medical record review. Personal and running variables between the injured and uninjured cadets were compared using independent t tests and chi-square analyses. Time to injury and hazard ratios (HRs) were estimated using Kaplan-Meier survival curves and Cox proportional hazard regression models, respectively.

Results: Of the 674 cadets who completed the study, 11% sustained a running-related injury. A significantly greater proportion of the injured participants were female (χ2 = 7.95; P = .005) and had a prior history of injury (χ2 = 7.36; P = .007). Univariate Cox proportional hazard regression models revealed greater injury risk in females (HR, 1.96; 95% CI, 1.22-3.16; P = .005) and cadets with a prior injury history (HR, 1.86; 95% CI, 1.18-2.93; P = .008). After adjusting Cox models for prior injury, females were found to be at a 1.89 times (95% CI, 1.17-3.04; P = .009) greater risk of injury. Running biomechanical variables were not associated with injury risk.

Conclusion: Study results indicated that non-modifiable risk factors such as female sex and prior injury history increased the risk of running-related injury in cadets undergoing military training. Running biomechanical variables measured by the wearable sensor were not associated with injury in this study.

Weart A., Brown L., Florkiewicz E., Freisinger G., East K., Reilly N., Song J., Goss D. (2025) Using Wearable Sensor Technology to Analyze Running Technique and Prospective Running-Related Injuries During United States Military Cadet Basic Training. Orthopaedic Journal of Sports Medicine. https://doi: 10.1177/23259671241309273

m Crowell, e florkiewicz, j morris, j mason, w pitt, t benedict, k cameron, d goss

Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery.

The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d’acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24–48 hours], 72 hours, 1 week, and 4 weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests.

Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F = 0.70, P = .54), VAS average pain (F = 0.99, P = .39), the POMS (F = 1.04, P = .37), or GROC (F = 0.43, P = 0.63). There was a significant main effect of time for VAS worst pain (F = 159.7, P < .001), VAS average pain (F = 122.4, P < .001), the POMS (F = 11.4, P < .001), and the GROC (F = 78.5, P < .001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4 weeks (t = 0.49, P = .63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy.

The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting.

Michael S Crowell, Erin M Florkiewicz, Jamie B Morris, John S Mason, Will Pitt, Timothy Benedict, Kenneth L Cameron, Donald L Goss, Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial, Military Medicine, 2025;, usae577, https://doi.org/10.1093/milmed/usae577

d rhon, s de la motte, j fraser, t greenlee, b hando, j molloy, d teyhen, j tiede, j van wyngaarden, r westrick, g bullock

Musculoskeletal injuries enact a substantial burden in military settings, incurring high costs, long-term disability, and impacting military readiness. This has led to a prioritization of injury prevention programs. Understanding the challenges faced by those trying to implement these programs could help standardize and better inform future efforts. The purpose was to capture perceptions of barriers and facilitators to implementation of injury prevention programs in the US Armed Forces.

A cross-sectional survey with open-ended questions was circulated to relevant stakeholders; key themes were derived using conceptual content analysis. Four questions were asked concerning injury prevention programs: 1) barriers, 2) facilitators, 3) how can leadership best support, and 4) how can subject matter experts best collaborate to make these programs successful?

The survey reached at least 300 individuals working with the armed services worldwide; 91 completed the survey. The mean (SD) time working with military service members was 11.5 (8.2) years; 93 % worked with active-duty service members, 71.4 % were licensed healthcare providers, and 55 % worked in settings with established injury prevention programs. Only 45.2 % of participants believed an appropriate, clear way to measure program success currently exists. Nearly 85 % believed that lacking standardization of definitions and metrics hinders program assessment. Wide variability existed in opinions regarding who should be primarily responsible for promoting/supporting injury prevention efforts. Key themes included resources as both a facilitator (when present) and barrier (when absent), organizational culture, and leadership support. Leadership can best help by prioritizing the programs and valuing the programming through modeling the desired behavior. Program staff can collaborate by focusing on enabling change, integrating into organizational/unit culture and collaborating with leaders to change policy.

Daniel I. Rhon, Sarah J. de la Motte, John J. Fraser, Tina A. Greenlee, Benjamin R. Hando, Joseph M. Molloy, Deydre S. Teyhen, Jeffrey M. Tiede, Joshua J. Van Wyngaarden, Richard B. Westrick, Garrett S. Bullock. Perceived barriers and facilitators to implementation of injury prevention programs in the military: feedback from inside the trenches, Injury. 2024. 112029. ISSN 0020-1383, doi.org/10.1016/j.injury.2024.112029.

b hando, v pav, b isaacson, c colahan, w funk, x yuan

The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS.

Ben Hando, Veronika Pav, Brad Isaacson, Courtney Colahan, Wendy Funk, Xiaoning Yuan, Musculoskeletal Injury Surveillance in the U.S. Military: Analysis of the ICD-10-CM Transition and Descriptive Report of Health Care Utilization at Four Sites Adopting MHS GENESIS, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 78–86, https://doi.org/10.1093/milmed/usad462

v pav, x yuan, b isaacson, w funk, b hando

Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Wendy Funk, Ben Hando, Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 70–77, https://doi.org/10.1093/milmed/usae245

b isaacson, b hando, p pav, l wagner, c colahan, p pasquina, x yuan

Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 56–69, https://doi.org/10.1093/milmed/usae046

x yuan, e stewart, c colahan, p pasquina, b isaacson, v pav

Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 45–55, https://doi.org/10.1093/milmed/usae248

b isaacson, b hando, v pav, l wagner, c colahan, p pasquina, x yuan

Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs.

Brad Isaacson, Ben Hando, Veronika Pav, Linzie Wagner, Courtney Colahan, Paul Pasquina, Xiaoning Yuan, Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 34–44, https://doi.org/10.1093/milmed/usae047

x yaun, e stewart, c colahan, p pasquina, b isaacson, v pav, b hando

Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021.

Xiaoning Yuan, Emma Stewart, Courtney Colahan, Paul Pasquina, Brad Isaacson, Veronika Pav, Ben Hando, Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 22–33, https://doi.org/10.1093/milmed/usae045

c colahan, v pav, x yuan, b isaacson, l wagner, b hando

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Courtney Colahan, Veronika Pav, Xiaoning Yuan, Brad Isaacson, Linzie Wagner, Ben Hando, Musculoskeletal Injuries in Female U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 10–21, https://doi.org/10.1093/milmed/usae308

V Pav, x yuan, b isaacson, c colahan, b hando

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period.

Veronika Pav, Xiaoning Yuan, Brad Isaacson, Courtney Colahan, Ben Hando, Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A 12-Year Study Spanning Fiscal Years 2010–2021, Military Medicine, Volume 189, Issue Supplement_4, November/December 2024, Pages 1–9, https://doi.org/10.1093/milmed/usae357

e Florkiewicz, k east, m crowell, a weart, g freisinger, d goss

In-clinic gait retraining has been effective in modifying suspected biomechanical risk factors for running injury, but its feasibility is often limited by multiple clinic visits. This randomized clinical trial investigated the effects of a telehealth-based gait retraining intervention on running biomechanics, pain, and function in previously injured runners.

Twenty-three participants recovering from lower extremity injuries were randomized to a control or intervention group. The intervention group completed 4 to 6 telehealth gait retraining sessions over 8 to 10 weeks, consisting of visual and verbal cues to transition to a non-rearfoot strike pattern and increase step rate. The control group received standard physical therapy. Biomechanics, pain, and function were assessed pre- and post-intervention using a 2 × 2 mixed model analysis of variance.

Half of the participants (55 %) in the intervention group successfully transitioned to a non-rearfoot strike pattern. No significant differences were observed between groups in step rate, biomechanics, or function. A significant group-by-time interaction for pain was observed (F = 10.55, P = 0.004), with the intervention group reporting greater reductions in pain compared to the control group (mean difference 2.52, 95 % CI 0.91 to 4.12).

Erin M. Florkiewicz, Kyle H. East, Michael S. Crowell, Amy N. Weart, Gregory M. Freisinger, Donald L. Goss. The effects of telehealth running gait retraining on biomechanics, pain, and function in patients with lower extremity injuries: A randomized clinical trial. Clinical Biomechanics, 2024. 106381, ISSN 0268-0033. https://doi.org/10.1016/j.clinbiomech.2024.106381.

martin c, nocera m, mercer j, marshall s, davi s, curtin j, cameron k

Mobile applications (apps) may be beneficial to promote self-management strategies to mitigate the risk of developing post-traumatic osteoarthritis in military members following a traumatic knee injury. This study investigated the efficacy of a mobile app in facilitating behavior modification to improve function and symptomology among military members.

This is a preliminary pre and post hoc analysis of a randomized control trial. The MARX scale, Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Knee Injury and Osteoarthritic Outcome Score Readiness to Manage Osteoarthritis Questionnaire were completed at baseline, 6-week, 6-month, and 12-month follow-up. Participants in the treatment arm completed the System Usability Scale. Data were analyzed using descriptive statistics, the Wilcoxon sum of ranks test, the Wilcoxon signed-rank test, and Cohen’s d effect size.

A total of 28 participants were included. Between-group differences for baseline and 6-week follow-up were significantly improved in the injured knee ICOAP constant pain score for the treatment group (treatment: −4.2 ± 12, 95% CI: −11.5, 3.1; control: 5.5 ± 9.9, 95% CI: 0.9, 10.1; P = .035, effect size = 0.905). Within-group differences for baseline and 6-week follow-up demonstrated a significant decline in the injured knee ICOAP constant pain score among the control group (signed-rank: 16.0, P = .031, Cohen’s d = 0.339). No other significant differences were observed. A good System Usability Scale score for usability was found (76.6 ± 8.8).

These results indicate that the mobile app is easy to use and may contribute to improved constant pain symptomology for patients at risk for post-traumatic osteoarthritis.

Chelsea Leonard Martin, Maryalice Nocera, Jeremy Mercer, Stephen W Marshall, Steven M Davi, Jessica J Curtin, Kenneth L Cameron, Efficacy of a Novel Telehealth Application in Health Behavior Modification and Symptomology in Military Service Members at Risk for Post-traumatic Osteoarthritis, Military Medicine, 2023;, usad435, https://doi.org/10.1093/milmed/usad435

cohen s, dohi t, munjupong s, qian c, chalermkitpanit p, pannangpetch p, noragrai k, wang e, williams k, christo p, euasobhon p, ross j, sivanesan e, ukritchon s, tontisirin n

The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI)

A randomized controlled trial was conducted in 146 patients undergoing an ESI at 6 hospitals in Thailand and the United States. Patients were allocated to receive immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or local anesthetic alone. The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale

Procedure-related pain scores with both VR (mean 3.7 (SD 2.5)) and sedation (mean 3.2 (SD 3.0)) were lower compared to control (mean 5.2 (SD 3.1); mean differences −1.5 (−2.7, −0.4) and −2.1 (−3.3, −0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (−0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3.7 (SD 0.9)) compared to the VR group (mean 4.1 (SD 0.5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group.

Steven P. Cohen, Tina L. Doshi, COL Sithapan Munjupong, CeCe Qian, Pornpan Chalermkitpanit, Patt Pannangpetch, Kamolporn Noragrai, Eric J. Wang, Kayode A. Williams, Paul J. Christo, Pramote Euasobhon, Jason Ross, Eellan Sivanesan, Supak Ukritchon, Nuj Tontisirin. Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections. The Lancet Regional Health Southeast Asia.2024 Volume27:100437. https://doi.org/10.1016/j.lansea.2024.10043; ISSN 2772-3682.

rhon d, greenlee t, lawson b, mccafferty r, gill n

To compare opioid use based on surgery intensity (low or high).

Higher-intensity procedures were associated with greater postoperative opioid use than lower-intensity procedures. Chronic opioid use was not significantly different between surgical intensity groups when considering only prior opioid use. Chronic opioid use was significantly higher among higher intensity procedures when accounting for surgical complications. The prresence of surgical complications is a stronger predictor of post-surgical long-term opioid use in high intensity surgeries than history of opioid use alone.

Rhon, Daniel I. PhD; Greenlee, Tina A. PhD; Lawson, Bryan MD; McCafferty, Randall MD; Gill, Norman W. DS. Assessment of Surgical Complications Strengthen the Relationship Between Spine Surgery Procedure Intensity and Chronic Opioid use After Surgery. Spine ():10.1097/BRS.0000000000005069, June 17, 2024. | DOI: 10.1097/BRS.0000000000005069

Juman L, Schneider E, Clifton D, Koehlmoos T

Injuries are the leading cause of medical encounters with over 2 million medical encounters for musculoskeletal (MSK) conditions and over 700,000 acute injuries per year. Musculoskeletal injuries (MSKIs) are by far the leading health and readiness problem of the U.S. Military. The Proceedings of the International Collaborative Effort on Injury Statistics published a list of 12 data elements deemed necessary for injury prevention in the civilian population; however, there are no standardized list of common data elements (CDEs) across the DoD specifically designed to study MSKIs in the Military Health System (MHS). This study aims to address this gap in knowledge by defining CDEs across the DoD for MSKIs, establishing a CDE dictionary, and compiling other necessary information to quantify MSKI disease burden in the MHS.

Luke Juman, Eric B Schneider, Dan Clifton, Tracey Perez Koehlmoos, Common Data Elements and Databases Essential for the Study of Musculoskeletal Injuries in Military Personnel, Military Medicine, 2024;, usae241, https://doi.org/10.1093/milmed/usae241