Response to and Perceptions of Low Back Pain Treatment in Initial Entry Training Soldiers: A Mixed Methods Study

PURPOSE AND BACKGROUND: The purpose of this study was to understand the experience of having low back pain (LBP) and undergoing treatment while in Initial Entry Training (IET) of active duty service members (ADSMs). The research questions were as follows: What are the clinically relevant changes in disability, function, and psychosocial risk factors after a multidisciplinary self-management intervention program? What is the experience of having low back pain and undergoing treatment while in IET as a military member?

LBP is one of the most common disabling conditions in developed countries, with health care utilization and lost productivity costs over $100 billion annually. LBP is one of the primary reasons military members seek medical care and is frequently reported in Medical Evaluation Boards (MEBs). Psychosocial risk factors, called yellow flags, have been identified as prognostic indicators of the development of a chronic LBP condition. Self-management interventions can be appropriate to address yellow flag symptoms. Such interventions may involve principles of cognitive–behavioral therapy (CBT), which helps clients identify negative thoughts and emotional reactions and create more adaptive behaviors.

Occupational therapy practitioners treat clients with LBP in work hardening settings and have a potential role in the military with LBP using CBT and pain neuroscience education, a treatment approach in which the clinician explains the neurological and physiological causes of pain to the client in easy-to-understand language. This approach can lead to decreased disability, pain, fear-avoidance behaviors, and catastrophizing. Ensuring effective LBP interventions may lead to decreased health-related costs and improved retention of service members.

METHOD: Ten participants undergoing IET and treatment for LBP were included in this mixed methods study. A self-management intervention of exercises and a psychosocial education class was provided. Quantitative data were obtained at baseline and 6-wk follow-up, and a qualitative data interview was conducted after treatment. Inclusion criteria were male and female ADSMs aged 18–42, primary complaint of LBP for any duration, English speaking, and written informed consent. Exclusion criteria were potential serious disorder related to LBP, spinal surgery within 24 mo, pregnancy, or pending MEB.

Quantitative data were gathered at baseline and 6-wk follow-up using a demographic questionnaire, the Oswestry Disability Index, the STarT Back Screening Tool, the Patient Reported Outcomes Measurement Information Systems Short Form Version 1, the Pain Catastrophizing Scale, and the Canadian Occupational Performance Measure (COPM). Colaizzi’s (1978) phenomenological analysis was used for the semistructured interviews.

RESULTS: Low levels of disability, pain catastrophizing, and psychosocial risk factors were reported at baseline and 6-wk follow-up. The COPM Satisfaction subscale was the only test with significantly improved scores (p = .037). Qualitative results revealed three main themes: the influence of military culture, the LBP experience of a trainee, and promoting the self-management of LBP.

CONCLUSION: IET ADSMs exhibited low levels of disability, pain catastrophizing, and psychosocial risk factors for LBP. However, qualitative reports indicated a negative impact of LBP on training participation, academics, and interpersonal relationships. Self-management interventions appear to be effective, but the constraints of a military training environment make seeking care and applying treatment strategies difficult. Occupational therapy practitioners can play a pivotal role on LBP multidisciplinary teams by providing training in relaxation exercises, strategies to combat negative thinking, and strengthening exercises and by incorporating use of the COPM.

References

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