Ziemke Gregg, Campello Marco, Hiebert Rudi, Weiner Shira Schecter, Rennix Chris, Nordin Margareta
Physical Therapy Department, Naval Medical Hospital Portsmouth, Portsmouth, VA, USA.
Clin Orthop Relat Res. 2015 Sep;473(9):2920-8. doi: 10.1007/s11999-015-4328-4.
Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team.
QUESTIONS/PURPOSES: Is a multidisciplinary spine team effective in limiting disability and attrition related to work-disabling spine conditions as compared with the current standard of care for US military active-duty service members?
This is a retrospective, pre-/post-study with a separate, concurrent control group using administratively collected data from two large military medical centers during the period 2007 to 2009. In this study, disability is expressed as the proportion of active-duty service members seeking treatment for a work-disabling spine condition that results in the assignment of a first-career limited-duty status. Attrition is expressed as the proportion of individuals assigned a first-career limited-duty status for a work-disabling spine condition who were referred to a Physical Evaluation Board. We analyzed 667 individuals assigned a first-career limited-duty for a work-disabling spine condition between 2007 and 2009 who received care at the Naval Medical Center Portsmouth or Naval Medical Center San Diego.
Rates of first-career limited-duty assignments for spine conditions decreased from 2007 to 2009 at both sites, but limited-duty rates decreased to a greater extent at the intervention site (Naval Medical Center Portsmouth; from 8.5 per 100 spine cases in 2007 to 5.1 per 100 cases in 2009, p < 0.001) as compared with the control site (Naval Medical Center San Diego; 16.0 per 100 spine cases in 2007 and 14.1 per 100 cases in 2009, p = 0.38) after the Spine Team was implemented in 2008. The risk of disability was lower at Naval Medical Center Portsmouth as compared with Naval Medical Center San Diego for each of the 3 years studied (in 2007, the relative risk was 0.53 [95% confidence limit {CL}, 0.42-0.68; p < 0.001]) indicating a protective effect of Naval Medical Center Portsmouth in limiting disability (in 2008, it was 0.58 [95% CL, 0.45-0.73; p < 0.001] and in 2009 0.34 [95% CL, 0.27-0.47; p < 0.001]); the relative risk improved in 2009 after the introduction of the Spine Team at Naval Medical Center Portsmouth. There were no differences observed in rates of attrition from the period before the introduction of the Spine Team to after at Naval Medical Center Portsmouth, and no overall differences could be statistically detected between the two sites.
This study provides suggestive evidence that a multi-disciplinary Spine Team may be effective in limiting disability. No conclusion can be drawn about the Spine Team's effectiveness in limiting attrition. Additional study is warranted to examine the effect of the timing of the introduction of multidisciplinary care for work-disabling spine conditions.
Level III, therapeutic study.
肌肉骨骼疾病是导致美国海军人员提前退役的最主要原因。本研究评估了脊柱治疗团队（一个由医生、物理治疗师和临床心理学家组成的多学科护理小组）对美国弗吉尼亚州朴茨茅斯海军医疗中心患有导致工作能力丧失的非特异性腰痛的现役军人的治疗效果。我们将脊柱治疗团队在限制因导致工作能力丧失的脊柱疾病而出现的残疾和减员方面的影响，与美国加利福尼亚州圣地亚哥海军医疗中心（该中心没有类似的脊柱治疗团队）的情况进行了比较。
问题/目的：与美国现役军人目前的护理标准相比，多学科脊柱治疗团队在限制因导致工作能力丧失的脊柱疾病而出现的残疾和减员方面是否有效？
这是一项回顾性的前后对照研究，设有一个单独的同期对照组，使用2007年至2009年期间从两个大型军事医疗中心行政收集的数据。在本研究中，残疾被定义为因导致工作能力丧失的脊柱疾病而寻求治疗并被分配到首个职业有限职责状态的现役军人的比例。减员被定义为因导致工作能力丧失的脊柱疾病而被分配到首个职业有限职责状态并被转介到体能评估委员会的人员比例。我们分析了2007年至2009年期间在朴茨茅斯海军医疗中心或圣地亚哥海军医疗中心接受治疗、因导致工作能力丧失的脊柱疾病而被分配到首个职业有限职责状态的667名人员。
两个医疗中心因脊柱疾病而被分配到首个职业有限职责状态的比例在2007年至2009年期间均有所下降，但干预组（朴茨茅斯海军医疗中心）的有限职责率下降幅度更大（从2007年每100例脊柱病例中的8.5例降至2009年的每100例中的5.1例，p < 0.001），而对照组（圣地亚哥海军医疗中心）在2008年实施脊柱治疗团队后，该比例从2007年每100例脊柱病例中的16.0例降至2009年的每100例中的14.1例（p = 0.38）。在研究的3年中，朴茨茅斯海军医疗中心的残疾风险均低于圣地亚哥海军医疗中心（2007年，相对风险为0.53 [95%置信区间{CL}，0.42 - 0.68；p < 0.001]），表明朴茨茅斯海军医疗中心在限制残疾方面具有保护作用（2008年为0.58 [95% CL，0.45 - 0.73；p < 0.001]，2009年为0.34 [95% CL，0.27 - 0.47；p < 0.001]）；朴茨茅斯海军医疗中心在2009年引入脊柱治疗团队后，相对风险有所改善。在朴茨茅斯海军医疗中心，从引入脊柱治疗团队之前到之后的减员率没有差异，两个医疗中心之间也没有发现总体上的统计学差异。
本研究提供了提示性证据，表明多学科脊柱治疗团队可能在限制残疾方面有效。关于脊柱治疗团队在限制减员方面的有效性尚无定论。有必要进行进一步研究，以探讨多学科护理对导致工作能力丧失的脊柱疾病的引入时机的影响。
三级，治疗性研究。
