Home Use Therapies for Pain, Disability, and Quality of Life in Military Service Members with a Musculoskeletal Injury: An Updated Systematic Review Meta-Analysis
Authors: Talbot Laura A , Wu Lin , Ramirez Vanessa J , Bradley David F , Scallan Ross , Zuber Pilar , Morrell Christopher H , Enochs Kayla , Fagan Mathias , Hillner Jesse , Metter E. Jeffrey 
Published: December 2024

ABSTRACT

Introduction
Musculoskeletal (MSK) injury can negatively affect service members by compromising job performance and readiness. These injuries can impact the service member’s physical health, functional abilities, and quality of life (QoL). Rehabilitation therapies for MSK injuries can reduce these impacts. One approach is home use rehabilitative therapy, usable during deployment and at home stations. The purpose of this updated systematic review with meta-analysis was to broaden our scope of pain/symptoms, disability, and QoL as outcome measures for nonpharmaceutical MSK therapies in a military population versus controls.

Materials and Methods
An updated systematic literature search was conducted from inception to September 2022 using electronic databases. From 2790 retrievals, 22 reports were identified from 21 randomized or nonrandomized control trials. Interventions included exercise, electrotherapy, bracing, and other devices compared to a standard control treatment. Outcomes for MSK pain/symptoms, disability, and QoL were summarized as (1) standardized change from baseline for both intervention and control by time and (2) standardized mean differences (SMDs) in the time change between the intervention and control.

Results
Relative to baseline, pain improved during treatment and follow-up (P &lt; .0001) with differences between intervention and control groups (P &lt; .0001) but no significant interactions between group and time (P = .11). Overall, interventions showed modest (0.33 SMD, 95% CI, 0.11 to 0.54) improvement relative to controls across body regions and time. On average, disability exhibited an SMD of 0.12 (95% CI, −0.20 to 0.44) across all measures with substantial heterogeneity (I2 = 0.93). Time (P = .02) but not intervention (P = .87) was a significant moderator with no clear pattern of change over time and no time by group interaction (P = .84). Quality of life had an overall modest effect with an SMD of 0.10 (95% CI, −0.04 to 0.24) with no evidence supporting a difference between the intervention and control groups (P = .10) and no significant interaction between time and group (P = .41). The QoL measures were primarily derived using the Short Form Health Survey (SF12/36), which provide a mental and physical component summary score. For the mental component, there was either no change or a small decline during the study (P(time) = .80), with a difference between the intervention and control (P = .04) but no interaction between groups over time (P = .40). For the physical component scale, there was improvement during the study (P = .01), with the intervention showing better improvement than the control (P = .005), with no interaction between the time and treatment/control group (P = .80). The report considers responses by region and individual treatments.

Conclusions
This analysis demonstrated modest improvement in pain and physical well-being with therapy, with low certainty across diverse military cohorts. The impact on overall health-related disability and QoL was limited, with little change in mental well-being. The substantial heterogeneity and low certainty across diverse military cohorts limit generalizability, suggesting that further research in homogeneous environments is important for guiding clinical decisions. The study’s findings suggest that nonpharmacological home use interventions may offer modest improvements in pain relief, particularly early in treatment, and in strength and function, according to our previous report. These interventions could complement standard care, providing options that may benefit service members during deployment and at home.