Research Activities
Two physicians and several members of the research support team were trained on procedures for the SX-One MicroKnife® with ultrasound guidance for carpal tunnel release.
In support of MIRROR Project #10, “Clinical Outcomes of Carpal Tunnel Release With and Without Ultrasound Guidance,” this training was the second-to-last in the series leading up to the beginning of study activities.
The cost of health care in the United States has increased exponentially over the past 60 years, soaring from $27.2 billion in 1960 (5% of gross domestic product) and $147 per resident to $3.5 trillion (17.9% of gross domestic product) and $11 000 per resident in 2017. Health care expenditures continue to rise significantly faster than the median household income, and this poses a financial strain for patients, providers, and the health care system alike. Removing unnecessary variation through evidence-based medicine is critical to improving outcomes and making care more affordable. This may be accomplished through standardized protocols, order sets, and check lists, with positive results previously demonstrated for obstetrics/gynecology, critical care, pediatrics, gastrointestinal surgery, orthopedics, and rehabilitation. Effective communication with a multidisciplinary team has also shown to enhance quality of treatment, reduce complications, and decrease postoperative issues. Although treatment normalization is a pragmatic solution for removing health care waste, evidence supports that even when guidelines are available, only two-thirds of patients receive the recommended care, and another quarter get treatment that may be unnecessary and/or harmful.
Isaacson B., Miranda M., Hager N., Wagner L., West S., Lucio W., Heller J., Dalgarno R., Dickens J., Schoomaker E., Pasquina P. (2020). Standardizing Postoperative Rehabilitation Protocols for the Tri-Service: A Consensus Meeting Hosted by the Musculoskeletal Injury Rehabilitation Research for Operational Readiness Organization. Military Medicine. https://doi.org/10.1093/milmed/usaa207
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.
Chronic exertional compartment syndrome is a debilitating condition primarily associated in highly active individuals with an estimated incidence of approximately 1 in 2000 persons/year. The etiology remains unclear to date. The differential diagnosis includes, but is not limited to stress fractures, medial tibial stress syndrome, and popliteal artery entrapment syndrome. Clinical signs and symptoms include pain in the involved compartment with exertion dissipating quickly after activity. Diagnostic tests include intramuscular compartment pressure testing, magnetic resonance imaging, near-infrared spectrometry as well as shear wave electrography. Treatments consist of nonsurgical, surgical, or the combination of the two. Gait retraining and the use of botulinum toxin appear most promising. Diagnostic lidocaine injections are emerging as a prognostic and mapping tool. Minimal invasive surgical options are being utilized allowing quicker return to activity and decreased morbidity. This article reviews the anatomy, clinical signs and symptoms, diagnostics, nonsurgical, and surgical treatments for chronic exertional compartment syndrome.
Velasco, Teonette O. PT, DPT, OCS; Leggit, Jeffrey C. MD, CAQSM. Chronic Exertional Compartment Syndrome: A Clinical Update. Current Sports Medicine Reports 19(9):p 347-352, September 2020. https://doi.org/10.1249/JSR.0000000000000747
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.
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.
This poster won the category of “Best Evidence-Based Practice” in the 12th annual DRP poster competition at WRNMMC.
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.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
These guidelines were created as a framework for the post-operative rehabilitation program. They DO NOT substitute for any specific restrictions or requirements that are determined through the necessary shared decision-making and collaboration between the operating surgeon and treating rehabilitation team.
It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for.
In these guidelines, we provide a framework for pain practitioners and institutions to balance the often-conflicting goals of risk mitigation for health care providers, risk mitigation for patients, conservation of resources, and access to pain management services. Specific issues discussed include general and intervention-specific risk mitigation, patient flow issues and staffing plans, telemedicine options, triaging recommendations, strategies to reduce psychological sequelae in health care providers, and resource utilization.
Pain Medicine, Volume 21, Issue 7, July 2020, Pages 1331–1346, https://doi.org/10.1093/pm/pnaa127
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgeries, procedures, and patient visits, including pain management services, have been postponed or cancelled. This has impacted the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognized during this pandemic for chronic pain patients include ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritizing necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the COVID-19 situation continues to evolve rapidly, these recommendations are based on the best available evidence and expert opinion at this present time and may need adapting to local workplace policies.
Shanthanna H., Strand N.H., Provenzano D.A., Lobo C.A., Eldabe S., Bhatia A., Wegener J., Curtis K., Cohen S.P., Narouze S. (2020). Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel. Anesthesia. https://doi.org/10.1111/anae.15076
