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An Analysis of Factors Affecting Outcome

Steven P. Cohen, MD; Conner Nguyen, MD; Shruti G. Kapoor, MD, MPH; Victoria C. Anderson-Barnes, BA; Leslie Foster, DO; Cynthia Shields, MD; Brian McLean, MD; Todd Wichman, MD; Anthony Plunkett, MD

Arch Intern Med. 2009;169(20):1916-1923.

Background  Back pain is the leading cause of disability in the world, but it is even more common in soldiers deployed for combat operations. Aside from battle injuries and psychiatric conditions, spine pain and other musculoskeletal conditions are associated with the lowest return-to-unit rate among service members medically evacuated out of Operations Iraqi and Enduring Freedom.

Methods  Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 1410 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to back pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (ie, return to theater or evacuate to United States) is rendered. Electronic medical records were then reviewed to examine the effect a host of demographic and clinical variables had on the categorical outcome measure, return to unit.

Results  The overall return-to-unit rate was 13%. Factors associated with a positive outcome included female sex, deployment to Afghanistan, being an officer, and a history of back pain. Trends toward not returning to duty were found for navy and marine service members, coexisting psychiatric morbidity, and not being seen in a pain clinic.

Conclusions  The likelihood of a service member medically evacuated out of theater with back pain returning to duty is low irrespective of any intervention(s) or characteristic(s). More research is needed to determine whether concomitant treatment of coexisting psychological factors and early treatment "in theater" can reduce attrition rates.

Author Affiliations: Pain Management Division (Dr Cohen), Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs Cohen and Kapoor); Department of Surgery (Dr Cohen), Department of Orthopedic Surgery and Rehabilitation (Ms Anderson-Barnes), Physical Medicine Service, Department of Orthopedic Surgery (Drs Foster and Wichman), and Anesthesia Service, Department of Surgery (Dr Plunkett), Walter Reed Army Medical Center, Washington, DC; Physical Medicine & Rehabilitation Service, Landstuhl Regional Medical Center, Landstuhl, Germany (Dr Nguyen); Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Shields); and Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii (Dr McLean).

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Arch Intern Med. 2009;169(20):1923-1924.
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