Preliminary trial of an online acceptance-based behavioural treatment for military, police, and Veterans with chronic pain
Abstract: Introduction: Chronic pain is a serious health issue in Canada but an even greater issue in military populations. Individuals experiencing chronic pain frequently find attending in-person treatment sessions difficult because of pain flare-ups, discomfort when travelling, and pain-related avoidance behaviours. These challenges function to maintain the pain cycle and prevent engagement in previously enjoyed activities. The purpose of this study was to gather preliminary evidence for the effectiveness of an online acceptance-based behavioural treatment of chronic pain designed specifically for military, police, and Veterans of these forces. Methods: In this preliminary trial, 15 participants engaged in an 8-week online treatment of chronic pain supplemented with optional biweekly group sessions. Participants completed pre- and post-treatment measures relating to key facets of the fear–avoidance model of chronic pain. Results: Participants' scores improved following treatment on measures of pain acceptance, kinesiophobia, and pain catastrophizing, and pain intensity ratings trended in the expected direction. Discussion: These preliminary results support the feasibility of our online acceptance-based treatment of chronic pain when combined with optional biweekly in-person group sessions.
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.