Leading Musculoskeletal Injury Care
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Scholarly Activities

Research Activities

Posts in Abstracts
Comparison of Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome (CECS) — ACP 2021

Miles R, Velasco T, Leggit J

This abstract won the Army Chapter of the American College of Physician's abstract competition and will be presented virtually in May 2021.

Chronic Exertional Compartment Syndrome (CECS) is a debilitating disorder that causes lower extremity pain most commonly in active populations. It is thought to arise from increased pressure in muscle compartments (commonly lower extremity anterior and lateral) leading to pain, paresthesia and an inability to tolerate exercise. The cause of CECS is unknown but is likely a combination of muscular, neurologic and vascular contributions. Current standard treatment is surgical fasciotomy, but it is only successful in 66% of patients. Many have complications and/or need repeat procedures. Efficacy is even worse in military members at 55%. Other alternative strategies have emerged such as botulinumtoxin A injections (BoNT-A) and gait retraining, but data is limited.

The objective of this study is to simultaneously assess the effectiveness of non-surgical treatments, BoNT-A injections and Supervised Gait Retraining (SGR), in terms of lower pain control and ability to return to full duty among adult active-duty service members suffering from lower extremity CECS, specifically of the anterior and/or lateral compartments.

Building Research Capacity and Infrastructure with the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) Organization — NIH Rehabilitation Research 2020

Isaacson B, Wagner L, West S, Lucio W, Dalgarno R, Johnston S, Fowler A, Pasquina P, Hager N

Musculoskeletal injuries (MSI) affect approximately 800,000 Service Members annually and result in 25 million limited duty days. These conditions are the primary reasons for medical discharge and downgrade, and result in 34% of evacuations from theatre. Given the strict requirements for physical fitness in the military and the impact of MSI on combat readiness, the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) organization was set up in 2019 to advance the treatment and preventive care for Service Members with non-combat related MSI. This abstract describes the purpose of MIRROR, how we support the Building Research Capacity and Infrastructure conference theme, and introduces new researchers to this collaborative forum.

The Effectiveness of Battlefield Acupuncture in Addition to Standard Physical Therapy Treatment after Shoulder Surgery: A Randomized Clinical Trial — MHSRS 2020

Crowell M, Brindle R, Mason J, Pitt W, Miller E, Posner M, Cameron K, Goss D

Abstract submitted to Military Health System Research Symposium 2020

There is a large incidence of shoulder instability among active young athletes and military personnel which requires shoulder stabilization surgery. Acute post-operative pain is common and is usually managed with opioid pain medications. The extended use of opioid medications can have adverse effects that impair function and reduce military operational readiness, and there are currently few alternatives. However, Battlefield Acupuncture (BFA) is a minimally invasive therapy demonstrating promise as a non-pharmaceutical intervention for managing acute post-operative pain.

Assessment of the Usability of the Rehabilitative Lower-Limb Orthopedic Accommodating Feedback Device — MHSRS 2020

Gaunaurd I, Symsack A, Thaper A, Springer B, Clemens S, Lucarevic J, Bennett C, Kristal A, Sumner M, Isaacson B, Pasquina P, Gailey R

Telerehabilitation, as a component of telemedicine, is a rapidly growing clinical tool being utilized in physical therapy, optimizing care for patients that are post-surgical, have orthopedic injuries, or who have undergone lower limb amputation (LLA). The benefits include greater access to care for patients in remote locations, reduced travel burden, and decreased time and financial costs. With this in mind, the Department of Defense (DoD) and Veterans Health Administration (VHA) collaborated to implement a telerehabilitation program called the Mobile Device Outcomes-based Rehabilitation Program (MDORP) designed to enhance the rehabilitation of injured Service Members (SMs) and Veterans with lower limb loss. MDORP is a home and community-based auditory biofeedback and prescription based exercise program which utilizes a sensor-based system called The Rehabilitative Lower-limb Orthopedic Accommodating-feedback Device (ReLOAD). This study aims to evaluate the feasibility and usability of ReLOAD over a 5-month period using an anonymous post-intervention survey of participating SMs and Veterans with LLA.

The Effectiveness of the DOD/VA Mobile Device Outcomes Based Rehabilitation Program (MDORP) for Service Members and Veterans with Lower Limb Amputation — WRNMMC DRP poster competition

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.

Intradiscal Injection of Dehydrated Human Amnion Chorion Membrane for Treatment of Chronic Discogenic Low Back Pain: A Case Series — ISPRM 2020

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.

Changed Tolerance of Cervical Collar and Weakness as the Initial Presentation of Deep Surgical Site Infection in Central Cord Syndrome Patient Status Post C25 Posterior Fusion — ISPRM 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.

Establishing the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) — EWI 2020

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.

Data and Analytics Infrastructure to Advance Musculoskeletal Injury Rehabilitation Research — EWI 2020

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.