Occupational Exposure to Whole Body Vibration Among U.S. Military Veterans: Acute and Chronic Contributions to Musculoskeletal Disorders and Spine-Area Pain, and the Role of Water
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 112
- 试验地点
- 1
- 主要终点
- Occupational Whole Body Vibration History
研究概览
简要总结
Significance to VA: There is a lack of prospective longitudinal studies investigating the relationship between risk factors to Veterans and development and progression of musculoskeletal (MSK) spine injury and pain. Military operational exposure to whole body vibration (WBV) is known to contribute to MSK disorders and pain. Our preliminary studies identified accelerated lumbar and cervical spine degenerative changes in military fighter pilots and helicopter aircrew compared to age- and sex-matched civilian controls. Those changes were likely associated with WBV that military aircrew experience during flight training, primarily affected intervertebral discs (IVDs) and endplates, were associated with neck and back pain symptoms and reduced functional capacity, and are likely to lead to lifelong spine-related issues. Therefore, these aircrew, and other military personnel that experience occupational WBV, are likely to enter the VA Healthcare system with pre-existing degenerative changes and spine-related pain symptoms that can progress over time. Similarly, many Veterans enter civilian occupations that involve WBV such as truck drivers and heavy equipment operators that may also have detrimental effects to the spine and lead to spine-related pain. Development of informed interventions and treatment protocols requires a mechanistic understanding of how the spine is acutely and chronically affected by occupational WBV from both structural and physiological perspectives. Innovation and Impact: Novel multi-parametric application of noninvasive magnetic resonance imaging (MRI) techniques such as arterial spin labeling (ASL), T2* decay from ultra short TE, and diffusion MRI can provide early objective indications of endplate degenerative state and IVD hydration and perfusion, and novel application of upright MR imaging allows for gravitational loading of the IVD while observing segmental and region IVD fluid distribution and transport patterns. Specific Aims: The goal of the proposed effort is to characterize the effects of previous military and current civilian occupational WBV on IVD and endplate health and degeneration (Aim 1), and segmental and regional IVD fluid distribution and transport differences (Aim 2). The endplates contain vasculature that permits IVD fluid exchange and may be linked to IVD fluid dynamics. We propose looking for connections between segmental and regional IVD fluid dynamics, degenerative state of the associated endplates, and WBV exposure (acute-controlled and longitudinal-occupational). Finally, we propose evaluating the impact of body hydration state on IVD fluid distribution and transport following acute (30 min) controlled WBV (Aim 3). Cumulatively, these results inform population-specific preventative measures to preserve endplate health for Veterans in occupations that present with WBV and identify potential areas for further research and targeted treatment of MSK disorders and MSK pain. Methodology: This study will explore acute and chronic changes to the structure and physiology of the spine by enrolling Veterans with prior military or current civilian occupation that involves daily WBV. Advanced MRI sequences will identify endplate sclerosis and physiological changes including disc hydration and perfusion. Acute effects of WBV will be assessed using pre/post MRI scans with experimental WBV. Path to translation/Implementation: Our existing relationships with VA clinicians, including spine surgeons, physical medicine and rehabilitation, and pain medicine, will ensure VA patient applicability of these findings and will help to translate any outcomes from this research and future studies directly into patient care.
详细描述
Musculoskeletal (MSK) disorders and spine-related pain are major health concerns among veterans. Low back pain is the most common chronic pain condition among Veterans, contributing significantly to healthcare utilization and rising treatment costs within the Veteran's Health Administration (VHA). As VHA community care expenditures more than doubled between 2017 and 2021, the growing demand for chronic pain services underscores the need for improved understanding of the mechanisms that contribute to spine degeneration in this population. There is evidence that occupational exposure to whole body vibration (WBV) is associated with an increased risk for a multitude of negative health outcomes, including MSK pain in the back and neck. However, despite extensive research on low back pain etiology and disc degeneration, major gaps persist around early detection of endplate degeneration and the impact of acute or chronic WBV exposure on IVD health.
The ubiquitous nature of low back pain in the general public but especially in veterans shows that there is a strong medical need for better understanding of the biomechanics of spine health. This study can help clinical practice by identifying early detection biomarkers with non-invasive MRI techniques and to investigate hydration as a protective mechanism.
The problem of low back pain and spine health is especially relevant within veterans because while service members are generally healthier than the typical U.S. adult of similar age at the time they enter service (because of rigorous physical and mental screening requirements to join the military, continued fitness standards, and access to comprehensive healthcare), research has shown that Veterans have poorer overall health-related quality of life than nonveterans and a high prevalence of back pain-related conditions. Veterans have often been exposed to WBV during their military career while in armored or heavy vehicles or in aircraft. Many veterans also continue to be exposed to WBV in their post-military careers with 28.5% working in natural resources, construction and maintenance or production, transportation and material moving. These jobs and many others may expose workers to WBV while operating vehicles (trucks, construction and heavy machinery), or operating tools where the vibrational amplitude is large enough to transmit to the body. These WBV exposures during their military career and post military career carries an increased risk of negative health outcomes including MSK pain in the back and neck.
While we know that many veterans are exposed to these conditions and they are associated with an increased risk of MSK pain, understanding the biomechanics will help understand how to prevent and treat those long term or chronic injuries. These are knowledge gaps that we have identified in relation to intervertebral disc health and exposure to WBV:
- Segment- and region-specific disc fluid dynamics under WBV are poorly understood.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 20 Years 至 45 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •English speaking; Male/Female Veterans age 20-45 years; BMI < 30; ability to sit upright for 60 mins; ability to drive to Deerfield, IL; ambulatory
排除标准
- •Previous spinal surgery; conditions/diseases associated with altered pain perception including neurological diseases (e.g., multiple sclerosis, trigeminal neuralgia, central sensitization), major psychiatric disorders, diabetes, neoplasm and cardiovascular disorders, chronic widespread pain diagnosis, pregnant women, MRI contraindications.
研究组 & 干预措施
Longitudinal effects of current or prior whole body vibration.
Determine the impact of acute and longitudinal WBV on lumbar spine endplate health. The objective is to perform a repeated measures study using multi-parametric MRI to assess Veteran endplate health. Veterans will participate in pain assessments and MRI scans annually for three years to track the progression of whole body vibration-related changes in the lumbar spine endplates and intervertebral discs. Current and prior whole body vibration characteristics will be correlated to pain scores and MRI changes.
Determine how lumbar disc fluid flow is acutely affected by whole body vibrati
The objective is to perform a repeated measures study to quantify changes in lumbar spine T2 relaxation times and volumetric MRI data following acute experimental vibrational exposure to determine fluid transport patterns and morphological changes. Veterans will participate in pain questionnaires, and receive Upright MRI scans prior to and immediately following 30 minutes of low magnitude whole body vibration. This unique protocol will allow us to assess acute changes in MR metrics and structural dimensions of the lumbar spine following exposure to WBV by comparing measurements obtained immediately following experimental WBV to pre-WBV measurements.
Effect of hydration on lumbar spine response to whole body vibration
This arm will determine whether individual hydration state influences IVD water dynamics following acute vibrational exposure. The objective is to assess the impact of hydration on IVD fluid distribution and transport in response to acute vibration utilizing multi-parametric MRI analysis. This will allow for evaluation of hydration as a potential factor for rehabilitation, treatment, and prevention of early degeneration related to WBV. MRI scans will be obtained under two conditions: hydrated and dehydrated. For the hydrated MRI scans, research subjects will be asked to consume a minimum of 2.7 liters of fluid per day for three days leading up the MRI date. For the dehydrated MRI scans, research subjects will be asked to consume about 1.3 liters of fluid per day for three days leading up to the MRI date. WBV induced changes to IVD water dynamics will be compared within subjects for the hydration, dehydration and control conditions.
干预措施: Water (Other)
结局指标
主要结局
Occupational Whole Body Vibration History
时间窗: Whole body vibration questionnaires will be provided at the time of enrollment and immediately prior to each MRI scan.
We will use questionnaires to quantify each subject's history with regard to occupational whole body vibration. Groups will include subjects that had whole body vibration while in the military, subjects that have current occupations with whole body vibration, and subjects that have not significant history of whole body vibration.
Oswestry Disability Index
时间窗: ODI will be collected at the time of enrollment and again immediately prior to each MRI scan.
Patient-reported outcome measure that assesses the degree to which low back pain impacts a person's daily functioning. The questionnaire consists of 10 sections (pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, traveling). Each section has 6 statements scored 0-5; patient selects the statement that best describes them.
次要结局
未报告次要终点
研究者
Brian D. Stemper
Research Health Scientist
Milwaukee VA Medical Center