Franz Anja, Lacasse Anaïs, Donelson Ronald, Tousignant-Laflamme Yannick
Canadian Armed Forces, 31 Canadian Forces Health Services Centre, 641 Cambrai Road, Borden, ON, Canada L0M 1B5.
Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, 445 boulevard de l'Université, Rouyn-Noranda, QC, Canada J9X 5E4.
Mil Med. 2017 Nov;182(11):e1957-e1966. doi: 10.7205/MILMED-D-17-00032.
Low-back pain (LBP) is a leading cause for disability in military personnel. Consequently, effective management strategies are required to maintaining operational capabilities. Physical therapy clinical practice guidelines recommend the use of directional preference (DP) to guide management. The effectiveness of this approach has not been tested in military personnel using a pragmatic study design. Pragmatic studies are ideal to inform clinicians and policymakers about the usefulness of proven interventions in real-life clinical conditions. The purpose of this study was therefore to determine, in clinical practice, the effectiveness of a management approach guided by DP vs. usual care (UC) physical therapy in Canadian Armed Forces (CAF) members with LBP.
A pragmatic study was conducted among 44 consecutive CAF members with LBP who received management guided by DP (n = 22) or UC (n = 22). Outcomes were pain intensity (primary outcome), pain location and frequency, perceived disability, medication use, perceived global effect (pain, function, overall status), work loss, and health care utilization. The effectiveness of the intervention was assessed at 1-month and 3-months follow-up.
Statistically significant differences favoring the DP group were observed for pain intensity (Δ 1 month: 1.9/10; 95% confidence interval [CI]; 0.97-2.89; Δ 3 months: 1.3/10; 95% CI: 0.35-2.31), pain location at 1 month (54.5% vs. 19.0%; p = 0.02) and 3 months (68.2% vs. 38.1%; p = 0.01), disability (Δ 1 month: 4.3/24; 95% CI: 2.12-6.38; Δ 3 months: 3.5/24; 95% CI; 1.59-5.33), perceived global effect at 1 month (pain: 86.4% vs. 57.1%; function: 81.8% vs. 47.6%; overall status: 86.4% vs. 57.1%) and 3 months (pain: 95.5% vs. 71.1%; overall status: 95.5% vs. 66.7%) with p values < 0.05, and improvement in work status at 3 months (54.5% vs. 23.8%; p = 0.04).
DP-guided management appears more effective than UC physical therapy to reduce pain and improve function in CAF members with LBP. Rapid improvements and the patient's ability to self-manage may prove especially advantageous in deployed settings. Our findings are particularly useful to inform military policymakers and clinicians on optimal management for CAF members.
腰痛（LBP）是军事人员致残的主要原因。因此，需要有效的管理策略来维持作战能力。物理治疗临床实践指南建议使用方向偏好（DP）来指导管理。这种方法的有效性尚未在军事人员中采用务实的研究设计进行测试。务实研究非常适合向临床医生和政策制定者告知已证实的干预措施在现实临床环境中的有用性。因此，本研究的目的是在临床实践中确定，对于患有腰痛的加拿大武装部队（CAF）成员，由DP指导的管理方法与常规护理（UC）物理治疗相比的有效性。
对44名连续患有LBP并接受DP指导管理（n = 22）或UC（n = 22）的CAF成员进行了一项务实研究。结果包括疼痛强度（主要结果）、疼痛部位和频率、感知到的残疾、药物使用、感知到的总体效果（疼痛、功能、总体状况）、工作损失以及医疗保健利用情况。在1个月和3个月的随访中评估干预措施的有效性。
在疼痛强度方面观察到有利于DP组的统计学显著差异（1个月时变化量：1.9/10；95%置信区间[CI]：0.97 - 2.89；3个月时变化量：1.3/10；95%CI：0.35 - 2.31），1个月时（54.5%对19.0%；p = 0.02）和3个月时（68.2%对38.1%；p = 0.01）的疼痛部位，残疾情况（1个月时变化量：4.3/24；95%CI：2.12 - 6.38；3个月时变化量：3.5/24；95%CI：1.59 - 5.33），1个月时（疼痛：86.4%对57.1%；功能：81.8%对47.6%；总体状况：86.4%对57.1%）和3个月时（疼痛：95.5%对71.1%；总体状况：95.5%对66.7%）的感知总体效果，p值<0.05，以及3个月时工作状态的改善（54.5%对23.8%；p = 0.04）。
对于患有LBP的CAF成员，DP指导的管理似乎比UC物理治疗在减轻疼痛和改善功能方面更有效。快速改善以及患者的自我管理能力在部署环境中可能特别有利。我们的研究结果对于告知军事政策制定者和临床医生关于CAF成员最佳管理方法特别有用。
