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. 2021 Jan 25;186(Suppl 1):502-505.
doi: 10.1093/milmed/usaa463.

Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Justin J Stewart  1 , Diane Flynn  2 , Alana D Steffen  3 , Dale Langford  4 , Honor McQuinn  2 , Ardith Doorenbos  4
Affiliations

Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Justin J Stewart et al. Mil Med. .

Abstract

Introduction: Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement.

Methods: Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile.

Results: The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later.

Discussion: This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC.

Conclusion: A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

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Figures

FIGURE 1.
FIGURE 1.
Process for patient inclusion and selection of injury profile (IPMC = Interdisciplinary Pain Management Clinic, PUL = Physical capacity/stamina, Upper extremity condition, Lower extremity condition, HES = Hearing Eyes, Psychology (categories of eProfile).
FIGURE 2.
FIGURE 2.
Predicted probability of Permanent Disability with 95% Confidence Interval across Time Since Initial Profile and Referral to Interdisciplinary Pain Management Clinic.
See this image and copyright information in PMC

References

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