Assessing the effects of non-pharmacological therapies on musculoskeletal pain: An individual participant data analysis of health-related quality of life in military personnel with family implications

Abstract: INTRODUCTION: Musculoskeletal injury is an inherent risk associated with military training and repeated combat deployment, which can negatively impact the well-being of the service member (SM) and their family. Musculoskeletal pain and inflammation compromise health-related quality of life (HRQoL) and can wield significant tolls that affect job performance, readiness, and family stability. Rehabilitation efforts for these injuries can be beneficial in reducing the impact on the military family. One strategy involves the use of non-pharmaceutical therapeutic interventions that are flexible enough to be implemented in the field during deployments and at home stations with minimal disruption to family life.This study examined the effectiveness of non-pharmaceutical musculoskeletal therapies on self-reported musculoskeletal pain and HRQoL using pooled individual-level data analysis; and secondly, from a SM's perspective, examined the potential impact to the military family's well-being as a result of these therapies. MATERIALS AND METHODS: Pooled individual participant data from 5 TriService Nursing Research Program funded trials were analyzed to assess the change in pain level and HRQoL over 9 weeks of treatment. Outcome measures consisted of the visual analog scale for musculoskeletal pain and the Short Form-12/36 Health Survey (SF12/36) for HRQoL. The SF12/36 examines 8 domains and composite Mental and Physical Component Summary (MCS and PCS) scores. Pain levels, the SF12/36 domains, and composite scores are all likely to be associated with family well-being from the SM's perspective. For comparison purposes, the interventions used during the 9 weeks of treatment were grouped into electrotherapy and standard care/exercise groups. RESULTS: Over 9 weeks of treatment, participants in both intervention groups exhibited improvement in pain (p(time) < 0.0001), with electrotherapy showing somewhat better improvement (p(interaction) = 0.02). As pain improved, the PCS scores on the SF12/36 survey improved (P < .001), with electrotherapy showing better improvement (p(interaction)=0.007) but on average never reaching the scale's population average. However, the SF12/36 MCS scores followed quite a different pattern. Overall, the MCS started above the population mean and exhibited a small decline during treatment (P = .01), with electrotherapy showing a slightly greater decline. However, after 9 weeks of treatment, both groups were above the population mean. The SF12/36 Social Functioning Domain is an indicator of the SMs capacity to reciprocate and engage with sources of social support, which is an important contributor to mental well-being and is associated with challenges for military families. Across the 9 treatment weeks, at each time point approximately 40% of SM had social functioning.Scores below 50 (chi-square test; P = .37), suggesting that the participant was exhibiting below-average social functioning that could impact their family. This was true for participants in the standard care/exercise (41%, chi-square test for time P = .16) and electrotherapy (40%, chi-square test for time P = .92) groups. Individuals experiencing difficulties in social functioning tended to report lower MCS Scores and slightly lower PCS Scores. No evidence was found for differences based on sex or marital status. CONCLUSIONS: Nine weeks of treatment with home-based interventions and standard care/exercise improved pain and physical well-being in participants with musculoskeletal injuries. During this period, participants' mental well-being remained stable or showed small declines. Service member reporting problems with social interactions tended to have lower physical and mental well-being and higher pain levels. This relationship may be important for individual SMs and their family members.