Group-based exercise training programs for military members presenting musculoskeletal disorders - A pragmatic randomized controlled trial

OBJECTIVE: To compare the effects of personalized supervised group-based programs (group physical therapy programs) to usual one-on-one physical therapy care (usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life and patients' satisfaction with their condition and care. DESIGN: Non-inferiority pragmatic randomized clinical trial. METHODS: One hundred and twenty military personnel from the Canadian Armed Forces, experiencing one of four targeted musculoskeletal disorders, were consecutively recruited, and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality of life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-squared tests were used to compare satisfaction. RESULTS: There were no significant Time x Group interactions for any of the primary and secondary outcomes (Time × Group p>.67). Satisfaction with treatment also did not differ between groups (p>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: p<.01), except for health-related quality of life (p=.13). CONCLUSION: Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care..