1. PICO by
Jarred Wolfe

2. Background
The Veterans Health Administration (VHA) treatment guideline for Posttraumatic Stress Disorder (PTSD) includes exercise as a Complementary and Integrated Health practice (CIH) that can safely and effectively treat PTSD (The Management of Posttraumatic Stress Disorder Work Group, 2017).
Veterans with combat-related PTSD have better outcomes in treatment when group cohesion is attained during treatment (Ellis, Peterson, Bufford, & Benson, 2014).

3. GAPS Analysis
Traditional PTSD VHA sponsored PTSD treatment programs do not include an exercise regimen in their programming.
Group cohesion is attained through traditional methods such as group therapy and admitting patients in cohorts during treatment in PTSD Residential Rehabilitation Treatment Program (RRTP).

4. PICO QUESTION
In Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND) male and female veterans diagnosed with PTSD and enrolled in a PTSD treatment program, what is the effect of adding a Crossfit ® exercise regimen on PTSD symptoms compared with the standard program treatment plan?  
Therapy/Intervention Template used

5. PICO Definitions Participants identified Intervention
OIF/OEF/OND Male and female veterans age enrolled in a PTSD treatment Program
Intervention
Crossfit ® work out 1 hour per day, 5 days per week throughout duration of PTSD RRTP
Other interventions to compare to
Routine care in PTSD RRTP
Type of outcome measures
PTSD Symptoms such as flashbacks, depression, anger outbursts
Rating group cohesion in cohorts

6. Population
According to the U. S. Department of Veterans Affairs (2017), there are currently 422,167 OIF/OEF/OND veterans utilizing VHA facilities for potential or provisional PTSD. The focus of this study will be those veterans enrolled in a Specialized Intensive PTSD Program (SIPP) such as PTSD RRTP.
Males and females will be eligible.
Age group years old.

7. Intervention
Greg Glassman defines Crossfit ® as “constantly varied, high-intensity functional movement” (Crossfit®, 2011).
1 hour workouts would be offered 5 days per week to study participants over the course of their PTSD RRTP treatment.

8. Comparison Group
Routine care in the PTSD RRTP includes (U. S. Department of Veterans Affairs, 2016):
Health assessments and testing on a 1:1 basis
Pharmacology
Family therapy and 1:1 psychotherapy
Group Therapy

9. Outcome
Primary outcome – a measurement of post-intervention PTSD symptomology (depression, anger outburst, nightmares, flashbacks, etc.) will be less than baseline as rated by a scale such as the PTSD Checklist for DSM-5 (PCL-5).
Secondary outcome – cohorts will rate group cohesion as stronger in intervention groups than non-intervention groups as rated by a scale such as the California Psychotherapy Alliance Scale – Group Version.

10. References
CrossFit ®. (2011). Greg Glassman - Defining Crossfit ®. Retrieved from
Ellis, C. C., Peterson, M., Bufford, R., & Benson, J. (2014). The importance of group cohesion in inpatient treatment of combat-related PTSD. International Journal of Group Psychotherapy, 64(2), doi: /ijgp
The Management of Posttraumatic Stress Disorder Work Group. (2017). VA/DOD clinical practice guidelines for the management of posttraumatic stress disorder and acute stress disorder. Retrieved from df

11. References
U. S. Department of Veterans Affairs. (2016). PTSD: National Center for PTSD. Retrieved from med/va-ptsd-treatment-programs.asp
U. S. Department of Veteran Affairs. (2017). Report on VA specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans diagnosed with potential or provisional PTSD: Cumulative from 1st qtr FY 2002 through 3rd qtr FY 2015 (October 1, 2001 – June 20, 2015). [Data file]. Retrieved from report-fy2015-qrt3.pdf