• Pain Med · Dec 2020

    Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE): Protocol for a Multisite Pragmatic Clinical Trial.

    • Shawn Farrokhi, Elizabeth Russell Esposito, Danielle McPherson, Brittney Mazzone, Rachel Condon, Charity G Patterson, Michael Schneider, Carol M Greco, Anthony Delitto, M Jason Highsmith, Brad D Hendershot, Jason Maikos, and Christopher L Dearth.
    • DOD-VA Extremity Trauma and Amputation Center of Excellence, Falls Church, Virginia.
    • Pain Med. 2020 Dec 12; 21 (Suppl 2): S45-S52.

    BackgroundPhysical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (CPGs) can improve the outcomes and cost-effectiveness of LBP care, PT CPG adherence remains below 50%. The Resolving the Burden of Low Back Pain in Military Service Members and Veterans (RESOLVE) trial will evaluate the effectiveness of an active PT CPG implementation strategy using an education, audit, and feedback model for reducing pain, disability, medication use, and cost of LBP care within the DOD and VA health care systems.DesignThe RESOLVE trial will include 3,300 to 7,260 patients with LBP across three DOD and two VA medical facilities using a stepped-wedge study design. An education, audit, and feedback model will be used to encourage physical therapists to better adhere to the PT CPG recommendations. The Oswestry Disability Index and the Defense and Veterans Pain Rating Scale will be used as primary outcomes. Secondary outcomes will include the LBP-related medication use, medical resource utilization, and biopsychosocial predictors of outcomes. Statistical analyses will be based on the intention-to-treat principle and will use linear mixed models to compare treatment conditions and examine the interactions between treatment and subgrouping status (e.g., limb loss).SummaryThe RESOLVE trial will provide a pragmatic approach to evaluate whether better adherence to PT CPGs can reduce pain, disability, medication use, and LBP care cost within the DOD and VA health care systems.Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020.This work is written by US Government employees and is in the public domain in the US.

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