Physical Therapy Targeting Autonomic and Dura Mater Function: SPINEPASS Randomized Clinical Trial Protocol

Area of Science:

• Neurology
• Physical Therapy
• Military Health

Background:

• Persistent post-traumatic headache (PPTH) is a significant challenge in military personnel, often unresponsive to pharmacological treatments.
• Headache characteristics frequently resemble migraines with associated autonomic nervous system (ANS) symptoms.
• Upper cervical spine hypermobility following concussion may trigger ANS responses and contribute to PPTH.

Purpose of the Study:

• To evaluate the efficacy of the SPINEPASS physical therapy program compared to standard physical therapy for treating PPTH.
• To assess patient experiences, acceptability, and feasibility of the SPINEPASS program.

Main Methods:

• A randomized controlled trial involving 120 active-duty military personnel with PPTH and ANS symptoms.
• Participants will receive up to 12 physical therapy sessions of either SPINEPASS or standard care.
• Outcomes include headache disability, self-confidence, acceptability, feasibility, ANS symptoms, and quality of life, with 3- and 12-month follow-ups.

Main Results:

• Primary outcomes focus on comparing headache disability between the SPINEPASS and standard physical therapy groups.
• Secondary outcomes include changes in ANS symptoms, pain self-efficacy, quality of life, and neck disability.
• Patient perspectives on self-confidence and management of headache will be evaluated.

Conclusions:

• The study investigates a novel non-pharmaceutical approach for PPTH in military personnel.
• SPINEPASS has the potential to decrease pain, disability, and medication dependence associated with PPTH.
• Potential limitations include challenges with recruitment and participant retention.