Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System: A Randomized Clinical Trial.

Importance: Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems.

Objective: To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP.

Design, Setting, And Participants: This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020.

Normative parameters and anthropometric variability of lumbar muscle stiffness using ultrasound shear-wave elastography.

Background: Quantifying stiffness of the lumbar spine musculature using shear-wave elastography (SWE) maybe beneficial in the diagnosis and treatment of non-specific low back pain (LBP). The primary purpose of this study was to establish normative parameter and variance estimates of lumbar spine muscle stiffness at rest and during submaximal contraction levels using SWE in healthy individuals. A second aim was to determine the relationship between lumbar spine muscle stiffness and a variety of demographic, anthropometric, and medical history variables.

Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial.

Objective: To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).

Design: Randomized clinical trial.

Setting: Orthopedic spine clinics.

Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial.

Background: Limited information exists regarding the cost-effectiveness of rehabilitation strategies for individuals with knee osteoarthritis (OA).

Objective: The study objective was to compare the cost-effectiveness of 4 different combinations of exercise, manual therapy, and booster sessions for individuals with knee OA.

Design: This economic evaluation involved a cost-effectiveness analysis performed alongside a multicenter randomized controlled trial.

Effect of Lumbar Progressive Resistance Exercise on Lumbar Muscular Strength and Core Muscular Endurance in Soldiers.

Objectives: Low back pain is common, costly, and disabling for active duty military personnel and veterans. The evidence is unclear on which management approaches are most effective. The purpose of this study was to assess the effectiveness of lumbar extensor high-intensity progressive resistance exercise (HIPRE) training versus control on improving lumbar extension muscular strength and core muscular endurance in soldiers.

The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial.

Study Design: Randomized clinical trial. Background The recommended initial management strategy for patients with low back pain and signs of nerve root compression is conservative treatment, but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests that a treatment protocol of mechanical traction and extension-oriented exercises may be effective, particularly in a specific subgroup of patients.

Incremental Effects of Telephone Call Center and Healthcare Utilization Database Use to Improve Follow-up Rate in the Prevention of Low Back Pain in the Military Trial.

Background: Studies that have relied exclusively on web-based surveys to secure follow-up have yielded inadequate follow-up rates, resulting in the need to explore whether supplementing with other methods results in incremental improvements. The primary purpose of this study was to determine the effectiveness of each follow up strategy that was used to collect the follow up data in our ongoing Prevention of Low Back Pain in the Military (POLM) trial.

Methods: This study represents a secondary analysis of the POLM trial.

The Incremental Effects of Manual Therapy or Booster Sessions in Addition to Exercise Therapy for Knee Osteoarthritis: A Randomized Clinical Trial.

Study Design: A factorial randomized controlled trial.

Objectives: To investigate the addition of manual therapy to exercise therapy for the reduction of pain and increase of physical function in people with knee osteoarthritis (OA), and whether "booster sessions" compared to consecutive sessions may improve outcomes.

Background: The benefits of providing manual therapy in addition to exercise therapy, or of distributing treatment sessions over time using periodic booster sessions, in people with knee OA are not well established.

Implications of early and guideline adherent physical therapy for low back pain on utilization and costs.

Background: Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).

Methods: Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool.

Implications of practice setting on clinical outcomes and efficiency of care in the delivery of physical therapy services.

Study Design: Retrospective analysis of episodes of care.

Objective: To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services.

Background: Many patients with musculoskeletal conditions benefit from care provided by physical therapists.

Criterion validity of manual assessment of spinal stiffness.

Assessment of spinal stiffness is widely used by manual therapy practitioners as a part of clinical diagnosis and treatment selection. Although studies have commonly found poor reliability of such procedures, conflicting evidence suggests that assessment of spinal stiffness may help predict response to specific treatments. The current study evaluated the criterion validity of manual assessments of spinal stiffness by comparing them to indentation measurements in patients with low back pain (LBP).

Physical therapist vs. family practitioner knowledge of simple low back pain management in the U.S. Air Force.

The purpose of this study was to compare knowledge in managing low back pain (LBP) between physical therapists and family practice physicians. Fifty-four physical therapists and 130 family practice physicians currently serving in the U.S.

Impact of an innovative clinical internship model in the US Army-Baylor Doctoral Program in physical therapy.

Study Design: Retrospective case-control.

Background And Purpose: Physical therapy education has been characterized by positive reform including the transition to doctoral level education and the emergence of evidence-based practice as a standard part of the curricula. However, clinical education remains largely unaffected by these advancements and continues as a highly fragmented and ill-equipped model marked by an inefficient 1:1 student to faculty ratio.

Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial.

Study Design: Randomized clinical trial.

Objectives: To examine the effectiveness of cervical traction in addition to exercise for specific subgroups of patients with neck pain.

Background: Cervical traction is frequently used, but its effectiveness has not been adequately examined.

Y-balance test: a reliability study involving multiple raters.

The Y-balance test (YBT) is one of the few field expedient tests that have shown predictive validity for injury risk in an athletic population. However, analysis of the YBT in a heterogeneous population of active adults (e.g.

Evolution of biomedical research during combat operations.

Background: The implementation of a human research protection program in Afghanistan and the mobilization of the combat casualty research team have made it possible to design and efficiently conduct multifaceted, multisite, and prospective research studies in a combat environment. Still, to conduct research in such an environment, several unique challenges must be overcome.

Methods: This article describes the development and conduct of three ongoing trauma-related biomedical research studies in Afghanistan, highlighting the challenges and lessons learned within the context of these studies.

The role of U.S. military physical therapists during recent combat campaigns.

U.S. military physical therapists have a proud history of providing medical care during operational deployments ranging from war to complex humanitarian emergencies.

Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.

Background Context: Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP.

Purpose: The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education.

Effect of two different exercise regimens on trunk muscle morphometry and endurance in soldiers in training.

Background: Limited evidence exists on how strength and endurance exercises commonly used to prevent low back pain affect muscle morphometry and endurance.

Objective: The purpose of this study was to analyze the effects of 2 exercise regimens on the morphometry and endurance of key trunk musculature in a healthy population.

Design: The study was designed as a randomized controlled trial.

Psychometric properties of selected tests in patients with lumbar spinal stenosis.

Background Context: The psychometric properties of many outcome tools commonly used with patients with lumbar spinal stenosis have yet to be examined.

Purpose: Examine the test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences for several outcome measures in a cohort of patients with lumbar spinal stenosis.

Study Design/setting: Cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy.