Efficacy of conservative interventions for musculoskeletal pain on disability and pain in active serving military personnel – A systematic review

Article


Bounds, Courtney L., Coppieters, Michel W., Thomson, Hayley W., Larsen, Brianna and Evans, Kerrie. 2023. "Efficacy of conservative interventions for musculoskeletal pain on disability and pain in active serving military personnel – A systematic review." Military Medicine: international journal of AMSUS. https://doi.org/10.1093/milmed/usac409
Article Title

Efficacy of conservative interventions for musculoskeletal pain on disability and pain in active serving military personnel – A systematic review

ERA Journal ID40335
Article CategoryArticle
AuthorsBounds, Courtney L., Coppieters, Michel W., Thomson, Hayley W., Larsen, Brianna and Evans, Kerrie
Journal TitleMilitary Medicine: international journal of AMSUS
Number of Pages10
Year2023
PublisherOxford University Press
Place of PublicationUnited States
ISSN0026-4075
1930-613X
Digital Object Identifier (DOI)https://doi.org/10.1093/milmed/usac409
Web Address (URL)https://academic.oup.com/milmed/advance-article/doi/10.1093/milmed/usac409/7017997?login=true
Abstract

Introduction
Musculoskeletal (MSK) injuries and associated pain disorders are one of the leading causes for soldiers not being medically fit for deployment, impacting force capability and readiness. Musculoskeletal pain continues to be a leading cause of disability within military services and is associated with a substantial financial burden. A better understanding of the effectiveness of MSK pain management strategies is required. This review was designed to determine the efficacy of nonsurgical interventions, such as physiotherapy, exercise, pharmacology, and multidisciplinary programs, to manage MSK conditions in active serving military populations.

Materials and Methods
MEDLINE, Embase, CINAHL, and SPORTDiscus were searched to identify relevant randomized clinical trials. Recommended methods were used for article identification, selection, and data extraction. The Cochrane Risk of Bias tool and the Grade of Recommendation, Assessment, Development, and Evaluation were used to appraise the studies. Where possible, meta-analyses were performed. The review was conducted according to the PRISMA guidelines.

Results
Nineteen articles (1,408 participants) met the eligibility criteria. Low back pain (LBP) was the most frequently investigated condition, followed by knee pain, neck pain, and shoulder pain. Early physiotherapy, exercise and adjunct chiropractic manipulation (for LBP), and multidisciplinary pain programs (physiotherapy, occupational therapy, and psychology) (for chronic MSK pain) improved pain (standardized mean difference ranged from −0.39 to −1.34; low strength of evidence). Participation in multidisciplinary pain programs, adjunct chiropractic manipulation, and early physiotherapy improved disability (for LBP) (standardized mean difference ranged from −0.45 to −0.86; low to very low strength of evidence). No studies evaluated pain medication. Dietary supplements (glucosamine, chondroitin sulfate, and manganese ascorbate), electrotherapy, isolated lumbar muscle exercises, home cervical traction, or training in virtual reality showed no benefit. The studies had a high risk of bias, were typically underpowered, and demonstrated high clinical heterogeneity.

Conclusions
Currently available randomized clinical trials do not provide sufficient evidence to guide military organizations or health care professionals in making appropriate treatment decisions to manage MSK pain in active serving military personnel. Future research is essential to enable evidence-based recommendations for the effective management of MSK pain conditions in this unique population.

KeywordsMusculoskeletal Conditions; Pain; Disability
ANZSRC Field of Research 2020420106. Physiotherapy
420799. Sports science and exercise not elsewhere classified
Byline AffiliationsGriffith University
Vrije University Amsterdam, Netherlands
Gold Coast University Hospital, Australia
School of Health and Medical Sciences
University of Sydney
Healthia Limited, Australia
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