Symsack A, Gaunaurd I, Springer B, Clemens S, Lucarevic J, Kristal A, Bennet C, Isaacson B, Applegate B, Gailey R, Pasquina P

This poster won the category of “Best Evidence-Based Practice” in the 12th annual DRP poster competition at WRNMMC.

Access the Poster

According to recent estimates, there are nearly two million people with lower limb amputation (LLA) currently living in the United States. This number is expected to double by 2050. Within the military, combat operations during the global war on terror have led to more than 1,700 service members (SMs) undergoing major limb amputation, with the majority experiencing LLA & many sustaining proximal and multiple limb loss. Those with LLA due to trauma are at a higher risk than nonamputees for multiple secondary health effects, which include joint pain, osteoarthritis, chronic lower back pain, & cardiovascular disease. In order to mitigate these adverse secondary health effects, optimize long-term function, & increase quality of life in individuals with LLA, effective rehabilitation and innovative life-long care is essential. Therefore, the Veterans Affairs (VA) & Department of Defense (DoD) implemented a program through the Joint Incentive Fund called the Mobile Device Outcomes-based Rehabilitation Program (MDORP). The primary objective of this pilot study was to determine if the implementation of MDORP improved strength, mobility, & gait quality in SMs and Veterans with LLA.

Lacey S, Cohen S, Jacobs M

Abstract submitted to the International Society of Physical and Rehabilitation Medicine 2020

Chronic low back pain is a major cause of morbidity in the U.S., with costs by some estimates exceeding $100 billion annually. Among the U.S. military population, back-related conditions have been associated with the highest 5-year cumulative risk of disability discharge. Patients with low back pain and intervertebral disc lesions identified on advanced imaging or discography are often diagnosed with “discogenic low back pain” (DLBP), which has a prevalence rate among axial low back pain sufferers estimated at 39 to 42%. The prognosis for DLBP is not favorable, with one prospective clinical study containing 279 patients finding that 87% of patients continued to have symptoms at 4 years of follow-up.

Lacey SA, Cohen SP, Jacobs MB. Intradiscal Injection Of Dehydrated Human Amnion Chorion Membrane For Treatment Of Chronic Discogenic Low Back Pain: A Case Series. Military Health System. International Society of Physical and Rehabilitation Medicine 14th World Congress. Orlando, FL; March 8, 2020.

Lacey SA, Kim G, Myers K

Abstracted submitted to the International Society of Physical and Rehabilitation Medicine 2020

60 year old man with cervical stenosis sustained a syncopal episode from a sitting height. He was found by a co-worker and reported being unable to move arms or legs. Diagnostic workup revealed C3-C4 fracture, ALL rupture and central cord syndrome. He underwent C2-C5 posterior fusion the next day and received post-operative course of steroids. Upon transfer to inpatient rehabilitation service on post-op day 11, patient was noted to have 4/5 strength in arms and 5/5 strength in legs. Patients who undergo inpatient rehabilitation after spine surgery should receive daily neurological exams and be monitored for increased pain or discomfort, especially in those with pre-operative and intra-operative risk factors.

Hager N, Isaacson B, Dickens J, Wagner L, Heller J, Lucio W, Rowland M, West S, Pasquina P

Abstracted submitted to Extremity War Injuries Symposium 2020

In order to enhance the DoD’s efforts in addressing the negative impact of MSI, we created MIRROR to study risk factors, generate prevention strategies, optimize treatments, and establish return-to-duty criteria that is based on scientific evidence rather than case-specific clinical judgment alone. Although the work at civilian facilities will be limited, investigators from these sites were included to engage national leaders in MSI research, ensure scientific rigor, enhance the mentorship of junior military clinical researchers, and scale these novel therapies for the general population.

Heller J, Roddy W, Isaacson B, Hager N, Pasquina P

Abstracted submitted to Extremity War Injuries Symposium 2020

View poster here

Within the MHS, data and analytics activities are commonly coordinated on an ad hoc basis using solutions like Microsoft Excel. This approach often acts as a barrier to efficient research and fails to scale. The development of a shared data and analytics infrastructure across MIRROR projects enables program information and insights to be communicated in an efficient, timely, and approachable manner. Ultimately, this allows military-relevant musculoskeletal injury rehabilitation research to be advanced in a data-driven way.