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Randomized Controlled Trial
. 2023 Nov 8;188(Suppl 6):20-33.
doi: 10.1093/milmed/usac432.

Predictors of Sustained Response to Functional Restoration in a Military Population

Diane M Flynn  1 , Larisa A Burke  2 , Jeffrey C Ransom  1 , Honor M McQuinn  1 , Alana D Steffen  2 , Tyler J Snow  1 , Ardith Z Doorenbos  2   3
Affiliations
Randomized Controlled Trial

Predictors of Sustained Response to Functional Restoration in a Military Population

Diane M Flynn et al. Mil Med. .

Abstract

Introduction: The purpose of this study was to determine if improvement in pain impact and functional performance following a functional restoration (FR) program was sustained up to 6 months posttreatment and to identify predictors of sustained improvement.

Materials and methods: Secondary analysis of data collected during randomized clinical trial. Study population included 108 US active duty service members who completed an FR program, as well as 3- and/or 6-month follow-up assessments. Primary outcome measure was the NIH Research Task Force (pain) impact score (PIS). Secondary outcome was a composite functional performance measure of treadmill, lifting, and carrying tolerances. Variables analyzed to determine their predictive value included demographics; treatment hours; measures of pain intensity, function, mood, sleep, social satisfaction, pain catastrophizing, kinesiophobia, self-efficacy, pain acceptance, patient activation, functional performance, and neuropathic pain.

Results: Mean PIS and functional performance improved significantly immediately following FR, but after 6 months, only improvement in functional performance sustained. Responder analysis showed that 6 months after FR, 42% of participants reported improvement that exceeded the minimal clinically important difference in PIS or functional performance. Predictors of sustained PIS improvement included younger age, absence of neuropathic pain features, less self-rated disability, better baseline functional performance, and worse baseline PIS. Predictors of sustained functional performance improvement included more treatment hours, lower baseline pain catastrophizing, and lower baseline functional performance.

Conclusions: This study supports the investment of treatment time in FR to yield sustained clinically meaningful improvement, as observed in over 40% of this study's military participants. Pretreatment predictors of sustained response included lower pain catastrophizing and absence of neuropathic pain. Further research is needed to determine if treatments that improve pain catastrophizing and neuropathic pain will result in sustained improvement in pain impact and functional performance following FR program participation.

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Conflict of interest statement

None declared.

Figures

FIGURE 1.
FIGURE 1.
Design of parent study.
FIGURE 2.
FIGURE 2.
Mean pain impact and functional performance scores and percentage whose improvement exceeded the minimal clinically important difference over time.
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See this image and copyright information in PMC

References

    1. Office of the Secretary of Defense : The implementation of a comprehensive policy on pain management by the Military Health Care System for fiscal year 2021. Washington, DC, December 2021. Available at https://health.mil/Reference-Center/Reports/2021/12/08/Comprehensive-Pol...; assessed August 13, 2022.
    1. Defense Health Agency : 6025.04 Pain management and opioid safety in the Military Health Care System. Washington, DC, June 2018. Available at https://health.mil/References/2018/06/08/DHA-PI-6025.04; assessed August 13, 2022.
    1. Skelly AC, Chou R, Dettori JR, et al. : Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Comparative Effectiveness Review No. 227 April 2020, Report No.: 20-EHC009. Rockville, MD: Agency for Healthcare Research and Quality. Available at https://www.ncbi.nlm.nih.gov/pubmed/32338846; assessed August 13, 2022. - PubMed
    1. Gatchel RJ, McGeary DD, Peterson A, et al. : Preliminary findings of a randomized controlled trial of an interdisciplinary military pain program. Milit Med 2009; 174(3): 270–7.doi: 10.7205/MILMED-D-03-1607. - DOI - PubMed
    1. Pujol LA, Sussman L, Clapp J, et al. : Functional restoration for chronic pain patients in the military: early results of the San Antonio military medical center functional restoration program. US Army Med Dep J 2015; Oct-Dec: 1–7. - PubMed

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