Group-based exercice training programs for military members presenting musculoskeletal disorders - protocol for a pragmatic randomized controlled trial

F Dupuis, K Perreault, L J Hébert, M Perron, Maj A Fredette, F Desmeules, J S Roy, F Dupuis, K Perreault, L J Hébert, M Perron, Maj A Fredette, F Desmeules, J S Roy

Abstract

Background: Musculoskeletal disorders are a leading cause of morbidity and the most prevalent source of disability among soldiers. Their high prevalence in armed forces and limited ressources have led to problems related to access to physical rehabilitation care. To increase access, supervised group-based exercise programs for the most prevalent musculoskeletal disorders (low back pain, patellofemoral pain, rotator cuff-related shoulder pain or lateral ankle sprain) have been developed at a Canadian Armed forces (CAF) base, but their effectiveness has not been evaluated. The primary objective of this randomized controlled trial is to evaluate the mid- and long-term effects of these group-based training programs on pain severity and functional limitations, in comparison with usual individual physiotherapy care. Secondary objectives include comparing both interventions in terms of health-related quality of life, pain-related fear, and patients' satisfaction.

Methods: One hundred and twenty soldiers with a new medical referral for physiotherapy services for one of the four targeted musculoskeletal disorders will be consecutively recruited. They will be randomly assigned to either group-based training program or usual individual physiotherapy care, and will take part in the assigned 12-week intervention. There will be four evaluation sessions over 26 weeks (baseline, week 6, 12 and 26). At each follow-up, functional limitations, pain severity, health-related quality of life and pain-related fears will be assessed. Patients satisfaction with treatment will also be evaluated at the end of the intervention period. Either two-way repeated measures ANOVA will be used to analyse and compare the effects of the interventions.

Discussion: This RCT will determine the effectiveness of group-based training programs compared to usual individual physiotherapy care. This new intervention model could represent an efficient, and more pro-active approach to manage a higher number of soldiers with musculoskeletal disorders. It could improve access to physical rehabilitation care and improve the health of soldiers.

Trial registration: ClinicalTrials.gov ( NCT05235152 ), February 11th 2022.

Keywords: Ankle sprains; Group-based intervention; Individual intervention; Low back pain; Musculoskeletal disorders; Patelofemoral pain syndrome; Physiotherapy; Randomized controlled trial; Rotator cuff related pain.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study design

References

    1. Cieza A, Causey K, Kamenov K, et al. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396:2006–2017. doi: 10.1016/S0140-6736(20)32340-0.
    1. Organization WH. Musculosketal conditons, (2019, accessed 07–01 2021).
    1. Lynch ME, Campbell F, Clark AJ, et al. A systematic review of the effect of waiting for treatment for chronic pain. Pain. 2008;136:97–116. doi: 10.1016/j.pain.2007.06.018.
    1. Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012;42:297–316. doi: 10.1016/j.semarthrit.2012.03.015.
    1. Passalent LA, Landry MD, Cott CA. Exploring wait list prioritization and management strategies for publicly funded ambulatory rehabilitation services in Ontario, Canada: further evidence of barriers to access for people with chronic disease. Healthc Policy. 2010;5:e139–e156.
    1. Passalent LA, Landry MD, Cott CA. Wait times for publicly funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in ontario, Canada. Physiother Can. 2009;61:5–14. doi: 10.3138/physio.61.1.5.
    1. Deslauriers S, Raymond M-H, Laliberté M, et al. Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada. J Eval Clin Pract. 2017;23:1489–1497. doi: 10.1111/jep.12838.
    1. Deslauriers S, Raymond M-H, Laliberté M, et al. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil. 2017;39:2648–2656. doi: 10.1080/09638288.2016.1238967.
    1. Deslauriers S, Déry J, Proulx K, et al. Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review. Disabil Rehabil. 2021;43:611–620. doi: 10.1080/09638288.2019.1639222.
    1. Besemann M, Hebert J, Thompson JM, et al. Reflections on recovery, rehabilitation and reintegration of injured service members and veterans from a bio-psychosocial-spiritual perspective. Can J Surg. 2018;61:S219–S231. doi: 10.1503/cjs.015318.
    1. Bergman BP, Miller SA. Unfit for further service: trends in medical discharge from the British Army 1861–1998. J R Army Med Corps. 2000;146:204–211. doi: 10.1136/jramc-146-03-10.
    1. Feuerstein M, Berkowitz SM, Peck CA., Jr Musculoskeletal-related disability in US Army personnel: prevalence, gender, and military occupational specialties. J Occup Environ Med. 1997;39:68–78. doi: 10.1097/00043764-199701000-00013.
    1. Pearl ML, Harris SL, Lippitt SB, et al. A system for describing positions of the humerus relative to the thorax and its use in the presentation of several functionally important arm positions. J Shoulder Elb Surg. 1992;1:113–118. doi: 10.1016/S1058-2746(09)80129-8.
    1. Hebert LJ, Rowe P. The lessons learned from the Canadian forces physiotherapy experience during the peacekeeping operations in Bosnia. Mil Med. 2007;172:829–834. doi: 10.7205/milmed.172.8.829.
    1. Group CFHS . Surgeon General’s Report 2010, Building on our strategy. 2010.
    1. Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012;98:101–109. doi: 10.1016/j.physio.2011.08.002.
    1. Dupuis F, Déry J, Perreault K, et al. Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: a systematic literature review. J Health Serv Res Policy. 2021;27(2):157–167. doi: 10.1177/13558196211065707.
    1. Keeffe M, Hayes A, McCreesh K, et al. Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Br J Sports Med. 2017;51:126. doi: 10.1136/bjsports-2015-095410.
    1. Group CFHS . Surgeon General’s Report 2014, Consolidation, Innovation, Readiness. 2014.
    1. Perron M, Gendron C, Langevin P, et al. Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain. BMC Musculoskelet Disord. 2018;19:–95. 10.1186/s12891-018-2022-x.
    1. Ager AL, Roy JS, Gamache F, et al. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med. 2019;184:e385–e393. doi: 10.1093/milmed/usy294.
    1. Dal-Ré R, Janiaud P, Ioannidis JPA. Real-world evidence: how pragmatic are randomized controlled trials labeled as pragmatic? BMC Med. 2018;16:49. doi: 10.1186/s12916-018-1038-2.
    1. Maughan EF, Lewis JS. Outcome measures in chronic low back pain. Eur Spine J. 2010;19:1484–1494. doi: 10.1007/s00586-010-1353-6.
    1. Emos MC and Rosner J. Neuroanatomy, Upper Motor Nerve Signs. 2021. PMID: 31082126.
    1. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50:350–372. doi: 10.2519/jospt.2020.9971.
    1. Manske RC, Davies GJ. Examination of the pattelofemoral joint. Int J Sports Phys Ther. 2016;11:831–853.
    1. Williams VJ, Piva SR, Irrgang JJ, et al. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther. 2012;42:716–723. doi: 10.2519/jospt.2012.4038.
    1. Hegedus EJ, Cook C, Hasselblad V, et al. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007;37:541–550. doi: 10.2519/jospt.2007.2560.
    1. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech. 2013;18:623–632.
    1. St-Pierre C, Desmeules F, Dionne CE, et al. Psychometric properties of self-reported questionnaires for the evaluation of symptoms and functional limitations in individuals with rotator cuff disorders: a systematic review. Disabil Rehabil. 2015:1–20. 10.3109/09638288.2015.1027004.
    1. Lewis J, McCreesh K, Roy JS, et al. Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther. 2015:1–43. 10.2519/jospt.2015.5941.
    1. Mehta SP, Fulton A, Quach C, et al. Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review. J Orthop Sports Phys Ther. 2016;46:200–216. doi: 10.2519/jospt.2016.6165.
    1. de Oliveira FCL, Pairot de Fontenay B, Bouyer LJ, et al. Kinesiotaping for the Rehabilitation of Rotator Cuff–Related Shoulder Pain: A Randomized Clinical Trial. Sports Health. 2020;13:161–172. doi: 10.1177/1941738120944254.
    1. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi: 10.1016/j.jbi.2019.103208.
    1. . US National Library of Medicine 2000.
    1. O'Sullivan P, Caneiro JP, O'Keeffe M, et al. Unraveling the complexity of low Back pain. J Orthop Sports Phys Ther. 2016;46:932–937. doi: 10.2519/jospt.2016.0609.
    1. Roy JS, Bouyer LJ, Langevin P, et al. Beyond the Joint: The Role of Central Nervous System Reorganizations in Chronic Musculoskeletal Disorders. J Orthop Sports Phys Ther. 2017;47:817–821. doi: 10.2519/jospt.2017.0608.
    1. Besen E, Gaines B, Linton SJ, et al. The role of pain catastrophizing as a mediator in the work disability process following acute low back pain. J Appl Biobehav Res. 2017;22:e12085. doi: 10.1111/jabr.12085.
    1. Schmidt R, Wrisberg C. Motor learning and performance: a situation based learning approach. 4. Champaign: Human Kinetics; 2008.
    1. Shumway-Cook AW. Motor control: translating research into clinical practice. Philadelphia: Wilkins LW; 2012.
    1. Roy J-S, Moffet H, Hébert LJ, et al. Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design. Man Ther. 2009;14:180–188. doi: 10.1016/j.math.2008.01.010.
    1. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 4th ed. Philadelphia; 2012. p. 641.
    1. Perron M, Moffet H, Nadeau S, et al. Persistence of long term isokinetic strength deficits in subjects with lateral ankle sprain as measured with a protocol including maximal preloading. Clin Biomech. 2014;29:1151–1157. doi: 10.1016/j.clinbiomech.2014.09.010.
    1. Bastien M, Moffet H, Bouyer LJ, et al. Alteration in global motor strategy following lateral ankle sprain. BMC Musculoskelet Disord. 2014;15:436. doi: 10.1186/1471-2474-15-436.
    1. Esculier JF, Roy JS, Bouyer LB. Lower limb control and strength in runners with and without patellofemoral pain. Submitted to Gait & Posture. 2014.
    1. Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, et al. Conservative interventions reduce fear in individuals with chronic low Back pain: a systematic review. Arch Phys Med Rehabil. 2020;101:329–358. doi: 10.1016/j.apmr.2019.08.470.
    1. Kapstad H, Rokne B, Stavem K. Psychometric properties of the brief pain inventory among patients with osteoarthritis undergoing total hip replacement surgery. Health Qual Life Outcomes. 2010;8:148. doi: 10.1186/1477-7525-8-148.
    1. Lapane KL, Quilliam BJ, Benson C, et al. One, two, or three? Constructs of the brief pain inventory among patients with non-cancer pain in the outpatient setting. J Pain Symptom Manag. 2014;47:325–333. doi: 10.1016/j.jpainsymman.2013.03.023.
    1. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9–19. doi: 10.1016/j.pain.2004.09.012.
    1. Keller S, Bann CM, Dodd SL, et al. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20:309–318. doi: 10.1097/00002508-200409000-00005.
    1. Dworkin RH, Turk DC, Wyrwich KW, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9:105–121. doi: 10.1016/j.jpain.2007.09.005.
    1. Franklin PD, Harrold L, Ayers DC. Incorporating patient-reported outcomes in total joint arthroplasty registries: challenges and opportunities. Clin Orthop Relat Res. 2013;471:3482–3488. doi: 10.1007/s11999-013-3193-2.
    1. Haute Autorité de Santé HAS . Choix méthodologiques pour l'évaluation économique à la HAS. Saint-Denis La Plaine: Guide méthodologique; 2020.
    1. Smeets R, Koke A, Lin CW, et al. Measures of function in low Back pain/disorders: low Back pain rating scale (LBPRS), Oswestry disability index (ODI), progressive Isoinertial lifting evaluation (PILE), Quebec Back pain disability scale (QBPDS), and Roland-Morris disability questionnaire (RDQ) Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S158–S173. doi: 10.1002/acr.20542.
    1. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low Back pain disability questionnaire and the Quebec Back pain disability scale. Phys Ther. 2001;81:776–788. doi: 10.1093/ptj/81.2.776.
    1. Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10.
    1. Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther. 2002;82:8–24. doi: 10.1093/ptj/82.1.8.
    1. Collins NJ, Misra D, Felson DT, et al. Measures of knee function. Arthritis Care Res. 2011;63(Suppl 11):S208–S228. doi: 10.1002/acr.20632.
    1. Durand MJ, Vachon B, Hong QN, et al. The cross-cultural adaptation of the DASH questionnaire in Canadian French. J Hand Ther. 2005;18:34–39. doi: 10.1197/j.jht.2004.10.010.
    1. Binkley J, Stratford P, Lott S, et al. The lower extremity functional scale (LEFS) scale development, measurement properties, and clinical application. Phys Ther. 1999;79:371–383.
    1. Alcock GK, Stratford PW. Validation of the lower extremity functional scale on athletic subjects with ankle sprains. Physiother Can. 2002;54:233–40.
    1. Tubach F, Ravaud P, al. e. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis. 2005;64:34–37. doi: 10.1136/ard.2004.023028.
    1. Tubach F, Dougados M, Falissard B, et al. Feeling good rather than feeling better matters more to patients. Arthritis Care Res. 2006;55:526–530. doi: 10.1002/art.22110.
    1. Ko V, Naylor J, Harris I, et al. One-to-one therapy is not superior to group or home-based therapy after Total knee arthroplasty: a randomized, superiority trial. JBJS. 2013;95:1942–49. doi: 10.2106/JBJS.L.00964.
    1. Rowe P, Hébert L. The impact of musculoskeletal conditions on the Canadian Forces. In: Aiken AB, SAH B, editors. Shaping the Future – Military and Veteran Health Research. Kingston: Defence Academy Press; 2011. pp. 377–391.

Source: PubMed

3
Abonner