24 March 2021

Bridging the Translational Research Gap: SMART Stepped Care Management Project

Researcher to Watch: MAJ (Ret) Dan Rhon, DPT, DSC

Translational research is often described as the “Valley of Death” since there is a large gap between basic research conducted in a lab and real-life clinical practice, in which many practical gaps still exist that could use more effective and efficient treatments, diagnostics, and prevention. Researchers and their teams are focused on translating information from labs to doctor’s offices and hospitals. This is sometimes referred to as the “bench to bedside” bridge.

MAJ (Ret) Daniel Rhon, DPT, DSC a Geneva researcher and the Director of the Primary Care Research Center at the Center for the Intrepid at Brooke Army Medical Center, has collaborated with Geneva on several of his translational research studies to advance military medicine. Dr. Rhon has been a Geneva employee since 2017 and Geneva has administered six of his studies to further his work in musculoskeletal and rehabilitative medicine.

Dr. Rhon leads several translational research projects managed by Geneva around pain management. Low back pain (LBP) is one of the most common forms of chronic pain and is a growing concern for the Military Health System (MHS). Rhon’s SMART Stepped Care Management Project supports an innovative Sequential Multiple Randomization Trial (SMART) specifically designed to address the Stepped Care treatment process. Stepped Care starts with a widely accessible, lower risk and less invasive interventions. Those who do not respond to initial treatments are stepped up to a more intensive treatment. “While Stepped Care has been beneficial for improving care in chronic conditions, many questions linger concerning which treatments to use within each Step, and the importance of the care decision sequence,” states Dr. Rhon. “This phase of this transitional research study aims to improve pain management for chronic LBP in the MHS by better integrating the biopsychosocial model and improving Stepped Care management.”

Continuing to the second phase of translational research, Dr. Rhon set specific aims to compare the effectiveness and cost-effectiveness of Step one and two of the Stepped Care approach for these patients. Sub-aims are to compare main effects of Step one and two treatment options and the sequencing effects of different treatment combinations. Additionally, Dr. Rhon plans to examine the SMART trial results in pre-specified sub-groups based on sex/gender, age, and pain-related co-morbidities (PTSD, sleep disturbance, post-concussive symptoms).

In another study led by Rhon which concluded in September of 2020, he and his team developed models to predict re-injury to the lower extremity. As a result, the team developed an optimal physical performance standard that should be met prior to discharge from physical rehabilitation in hopes of decreasing future injury risk and successfully returning service members optimally ready to perform their military duties.

“Musculoskeletal health is the biggest medical problem the military is currently facing and our team is on a mission to improve these outcomes in the real world,” states Dr. Rhon. “With the translational research methods, we aim to address service members and veterans’ critical medical needs and improve their quality of life.”

 

Disclaimer: The views expressed do not reflect the official policy of the Army, the Department of Defense, or the U.S. Government.