Use of the CAREN system as a treatment adjunct for Canadian Armed Forces members with chronic non-specific low back pain: a pilot study
Abstract: Non-specific chronic low back pain (cLBP) is a significant concern for the Canadian Armed Forces (CAF). Some CAF members develop pain-related fear of movement that is difficult to treat. The goal of this pilot study was to test the feasibility of applying a virtual reality exercise program using the Computer Assisted Rehabilitation Environment (CAREN) with CAF members with cLBP and kinesiophobia. Participants were randomized into one of two treatment groups or a control group. The treatment groups received 10 CAREN sessions over 2.5 weeks (high intensity) or over 5 weeks (low intensity), and the control group received exercise instruction alone. A standard CAREN protocol using five applications was used to encourage trunk movement and stability. Eleven participants were recruited. Both CAREN treatment protocols were feasible, with 100% attendance, and CAREN performance continued to improve over the 10 sessions with no plateau. CAREN participants showed stable or slightly improved scores on outcome measures from baseline to post-intervention. Participants showed no consistency on the physical performance measures, with ceiling effects or variability noted between participants. Significant inferences regarding effectiveness cannot be made because of the low number of participants. The CAREN treatment protocol was shown to be feasible and well tolerated at these intensities. The outcome measures that show the most promise for future study include the Oswestry Disability Index, Fear of Daily Activities Questionnaire, Edgren Side Step Test, and 30-second chair stand. Future randomized controlled trials to study the effectiveness of the CAREN intervention should include military-relevant outcomes and cost efficiency.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.