Other Educational Activities

Sharing of Knowledge Products to Improve Care, will support new education/learning from LOEs #1-3. Findings will be shared in publications, abstracts, book chapters, consensus meetings, etc. Work will be facilitated by students (undergraduate and graduate), faculty, providers, etc. The MIRROR team will help to organize activities and the intent is to adopt lessons learned and make sure that they get to the bedside of clinical care in the military and civilian environments. A few examples of potential activities are as followed

A. Consensus Meetings for Standardizing Care
MIRROR hosted more than 50 military leaders, clinicians, scientists and subject-matter experts within the physical therapy, orthopaedics, physical medicine and rehabilitation, and pain management fields for two all-day consensus meetings to help advance service member care and identify best practices within the Army, Navy and Air Force. The deliverable was 18 post-operative protocols that were approved for Tri-Service care. All protocols can be found on the MIRROR website and are freely available for the military and civilian communities. A comprehensive list are as followed: (1) Tibial Tubercle Osteotomy, High Tibial Osteotomy, (3) Clavicle Repair, (4) Anterior Cruciate Ligament Reconstruction (ACLR), (5) Ankle Scope with Cartilage Restoration, (6) Ankle ORIF, (7) AC Joint Reconstruction, (8) Achilles Tendon Non-Operative, (9) Achilles Tendon Repair, (10) Reconstruction - Modified Brostrom, (11) Arthroscopic Hip, (12) Arthroscopic Knee, (13) Arthroscopic Shoulder, (14) Bicep Tenodesis, (15) Meniscus Repair, (16) Patellar Tendon, (17) Rotator Cuff Repair, and (18) Shoulder Instability. In this grant application, MIRROR, in collaboration with CHAMP, CHSR, and other federal and non-federal partners to host two additional consensus meetings to address DLMCs related to MSKI, which will be codified and disseminated within the DHA clinical communities and USU educational programs, as well as published for broader dissemination within the MHS, VA and civilian medical communities.

B. Lessons Learned from NIH-DoD-VA Pain Management Collaboratory (PMC)
The PMC (https://painmanagementcollaboratory.org) is comprised of 11 large-scale, multisite, pragmatic clinical trials that focus on implementation and evaluation of nonpharmacological approaches for the management of pain and common co-occurring conditions in Military and Veterans healthcare systems. The trials are outlined in Exhibit A. Within LOE 4, we will evaluate the results of the ongoing PMC trials, and leverage the relationship that exists between the Pain Management Collaboratory Coordinating Center (PMC3) https://painmanagementcollaboratory.org/home/pmc3/ to disseminate these findings and facilitate clinical implementation practices. There is growing awareness that pain, both acute and chronic, and its management is a significant public health concern. Evidence documents that Military Service Members and Veterans living in the United States today report pain at particularly high rates, many of whom were among the 2.5 million active military deployed since 2001 in Operations Enduring Freedom, Iraqi Freedom, and New Dawn in Iraq and Afghanistan. In this population, pain may be particularly complex, since it frequently coexists with other medical and mental health and substance use disorders and behavioral health and social risk factors, among other issues. “Relieving Pain in America: A Blueprint for Transforming Pain Prevention, Care, Education, and Research” from the National Academy of Medicine (formerly, the Institute of Medicine) and the National Pain Strategy published by the US Department of Health and Human Services have helped to usher in a period of transition in the approach to pain management. Informed by the acknowledgement of pain as a public health crisis, these policy statements call for a comprehensive transformation in the way pain is assessed and managed. Authors highlight that pain care should be patient-centered, integrated, evidence-based, multimodal and interdisciplinary, replacing the currently common approach in which pain is managed by monotherapy delivered by a single provider. With growing concerns over the harms associated with pharmacological and invasive medical procedures, there has been a shift towards recommendations for multimodal care that incorporates nonpharmacological approaches to pain management as first-line therapy. These recommendations are supported by growing evidence of their effectiveness and minimal associated risks.

C. MSKI Evaluation and Treatment Education for Primary Care Providers
Results from clinical and research activities that are performed in this grant application will be incorporated into training for improving MSKI evaluation and treatment among DoD, Veterans Affairs, and civilian primary care providers.

D. Education for Graduate Studies
Clinical and research activities that are performed in this grant application will be further studied and deployed in the military and civilian communities. Efforts may include new graduate work to support Masters and Doctorate students, new pilot studies, etc.