Back PAIN Treatment Behaviors of the U.S. Military Aged Population: Considerations for H2F

Background/Purpose: The United States Army recently introduced the Holistic Health & Fitness (H2F) System to address the epidemic of musculoskeletal injuries (MSKI) on readiness. Of all MSKIs, lower back pain (LBP) has a significant biopsychosocial impact on civilian and military populations. Using an Anderson Behavioral Model to understand treatment utilization behaviors for the association between predisposing and need factors and utilized LBP treatments were analyzed. Soldiers originate from the civilian community, so it is crucial to understand the LBP interventions civilians use prior to enlisting or commissioning into the military to guide H2F’s implementation toward improved readiness. This study aimed to identify determinant factors associated with LBP treatments in the general military-aged U.S. population to understand which interventions to incorporate into H2F.

Methods: Data and samples: A secondary data analysis was conducted using 2019 National Health Interview Survey (NHIS) cross-sectional data. The analytic sample (n=2446) included non-incarcerated adult Americans with back pain, ages 18 to 45 (military aged), with health insurance and employment (access to care). The association between predisposing and need determinants were tested using logistic regression models. Measures: Predisposing determinant predictor variables were sociodemographic characteristics: age, gender, race/ethnicity, and socioeconomic factors. Need determinant predictor variables were back pain severity, chronic LBP (cLBP), and High Impact cLBP. Utilization Health Behavior outcome variables were reported use of Provider-managed and Self-managed treatments for LBP.

Results: Results from a nationally representative sample of 2446 civilian participants found that 49% utilized a form of Provider-managed or Self-managed treatment to reduce back pain. Women had higher odds of seeking care compared to men while controlling for pain severity. Hispanics and Black Americans were more likely to use relaxation and massage pain treatments compared to Whites. Younger people were more likely to use yoga for pain reduction. Of all pain treatments, men had the best odds of utilizing chiropractic care and physical and occupational therapies. People with pain affecting their life and work had higher odds of using cognitive and behavioral interventions.

Conclusions and Implications: H2F integrates leadership, training, fitness, and medical care to improve Soldiers’ longevity and lethality. I found that predisposing factors are predictive of pain treatment utilization beyond pain severity. Men and younger age groups were less likely to utilize pain treatment overall, presenting challenges for the Army which is disproportionately younger and male.

The findings also reveal that chiropractic care, massage, physical therapy, meditation, and yoga are associated with increased utilization within military populations. This has implications for the Army as neither massage nor chiropractic services are currently available to Soldiers. Future programs and policies should increase Soldiers' access to pain interventions they are likely to use, which would help ameliorate pain before becoming chronic or disabling. Understanding that Soldiers are predisposed to MSKI and LBP, the Army should incorporate these five interventions into H2F. Yoga and relaxation could be taught as self-managed techniques to be incorporated into Soldiers’ training routines, and Army leaders should consider increasing access to massage and chiropractic services.