Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study

Granado, Nisara S.; Pietrucha, Amanda; Ryan, Margaret A. K.; Hooper, Tomoko I.; Smith, Besa; Smith, Tyler C.

doi:10.1097/brs.0000000000001739

Cited by 7 publications

(3 citation statements)

References 49 publications

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“…These factors taken together may explain why even though the 9‐item STarT Back tool is meant to account for baseline disability and a range of psychological risk factors, the future risk of persistent disabling LBP in VA primary care is still substantially higher than expected. Prior studies have suggested greater risk of LBP with combat exposure, 39 active duty status 40 and periods of wearing body armor, 41,42 and other exposures or injuries specific to military service may also play a role 43 . These factors may confer a poor prognosis in Veterans and are not directly captured by the STarT Back items.…”

Section: Discussionmentioning

confidence: 99%

Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool

Kneeman

Battalio

Korpak

et al. 2020

PM&R

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Background The Subgrouping for Targeted Treatment (STarT Back) is a stratified care approach to low back pain (LBP) treatment. The predictive validity of STarT Back in Veterans Affairs (VA) primary care has not been demonstrated. Objective To examine the validity of the STarT Back tool for predicting future persistent disabling LBP in VA primary care. Design Cohort study. Setting VA primary care in Washington State. Participants Veterans seeking care for LBP in VA primary care clinics. Interventions Not applicable. Main Outcome Measures The STarT Back tool was used to classify Veterans according to their baseline risk group (low vs medium vs high). The primary study outcome, persistent disabling LBP, was defined as a Roland‐Morris Disability Questionnaire (RMDQ) score ≥ 7 at 6‐month follow‐up. Analyses examined discrimination and calibration of the baseline STarT Back risk groups for prediction of persistent disabling LBP at 6‐month follow‐up. Results Of the study sample, 9% were female and 80% reported longstanding LBP (>5 year duration). Among 538 participants, the baseline STarT Back risk groups were associated with future persistent disabling LBP at 6‐month follow‐up. Within each baseline STarT Back risk group, the proportions with future persistent disabling LBP at 6‐month follow‐up were 54% (low risk), 88% (medium risk), and 97% (high risk). The baseline STarT Back risk groups had useful discrimination (area under the curve [AUC] 0.79) for predicting future persistent disabling LBP, but the proportion of Veterans with persistent disabling LBP at 6‐month follow‐up was substantially higher than that observed in non‐VA primary care settings. Conclusions The STarT Back risk groups had useful discrimination (AUC = 0.79) for future persistent disabling LBP, but calibration was poor, underestimating the risk of persistent disabling LBP. The STarT Back tool may require updating for use in VA primary care.

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Section: Discussionmentioning

confidence: 99%

Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool

Kneeman

Battalio

Korpak

et al. 2020

PM&R

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“…For example, combat exposure has been associated with new-onset cardiac problems, 6 new-onset pulmonary compaints, 7 and a higher prevalence of somatic symptoms. 5,11 Further, wartime service has been associated with poorer health trajectories among older veterans. 12 Self-reported physical health functioning has been associated with obesity, sedentary behavior, morbidity, hospitalization, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Combat and Trajectories of Physical Health Functioning in U.S. Service Members

Porter

Bonanno

Bliese

et al. 2019

American Journal of Preventive Medicine

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Introduction: Previous research has demonstrated that different forms of mental health trajectories can be observed in service members, and that these trajectories are related to combat. However, limited research has examined this phenomenon in relation to physical health. This study aims to determine how combat exposure relates to trajectories of physical health functioning in U.S. service members.Methods: This study included 11,950 Millennium Cohort Study participants who had an index deployment between 2001 and 2005. Self-reported physical health functioning was obtained 5 times between 2001 and 2016 (analyzed in 2017), and latent growth mixture modeling was used to identify longitudinal trajectories from these assessments. Differences in the shape and prevalence of physical health functioning trajectories were investigated in relation to participants' self-reported combat exposure over the index deployment.Results: Five physical health functioning trajectories were identified (high-stable, delayed-declining, worsening, improving-worsening, and low-stable). Combat exposure did not influence the shape of trajectories (p=0.12) but did influence trajectory membership. Relative to personnel not exposed to combat, participants reporting combat exposure were more likely to be in the delayeddeclining, worsening, and low-stable classes and less likely to be in the high-stable class. However, the high-stable class (i.e., the most optimal class) was the most common trajectory class among not exposed (73.0%) and combat-exposed (64.5%) personnel.Conclusions: Combat exposure during military deployment is associated with poorer physical health functioning trajectories spanning more than a decade of follow-up. However, even when exposed to combat, consistently high physical health functioning is the modal response.

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“…5,[8][9][10][11][12][13] Determining who might be at risk for chronic pain after deployment is essential. Previous studies have shown that in soldiers deployed to Afghanistan and Iraq the following characteristics are associated with postdeployment pain: older age (>30 years), 6 being married or previously married, 6 exposure to combat 6,14 (especially injury during combat 6 ), duty involving heavy physical labor, 6 and PTSD and other psychiatric conditions. 6,15 Demographic and combat factors are rarely modifiable, and PTSD and other psychiatric comorbidities tend to be the sequelae of deployment 16 rather than useful predeployment determinants of the development of pain.…”

Section: Introductionmentioning

confidence: 99%

Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers

et al. 2019

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Key Points Question Are higher levels of predeployment optimism among US Army soldiers associated with fewer reports of new pain after deployment? Findings Among 20 734 US Army soldiers in this longitudinal cohort study, optimism was associated with 11% lower odds of reporting new postdeployment pain, even while adjusting for demographic, military, and combat factors, including traumatic experiences and combat injury. In addition, 37.3% of soldiers reported pain in at least 1 new area of the body after deployment. Meaning The findings suggest that soldiers with low levels of predeployment optimism may be at greater risk of developing new postdeployment pain and may benefit from scalable interventions designed to increase optimism.

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Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study

Cited by 7 publications

References 49 publications

Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool

Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool

Combat and Trajectories of Physical Health Functioning in U.S. Service Members

Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers

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