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McDermott MC, Musilli MG, Brown JE, Melton JL, Miller MJ, Allard RJ, Lutgendorf MA. Female-Specific Health Care of Military Female-Designated Service Members and Veterans: A Systematic Overview of Reviews. Mil Med 2024; 189:e1917-e1930. [PMID: 38537156 DOI: 10.1093/milmed/usae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 08/31/2024] Open
Abstract
INTRODUCTION Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations. MATERIALS AND METHODS On May 10, 2022, a medical librarian performed a comprehensive search across five databases (Ovid Medline, Embase, CINAHL, PsycINFO, Ovid All EBM Reviews, and Web of Science) for all relevant reviews published from 2000 to May 10, 2022. Results were limited to English language. After the removal of duplicates, 2,438 records were reviewed, and 69 studies were included in the final review. The search strategy and methods were registered with PROSPERO and are reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Two independent reviewers conducted title and abstract screening and subsequent full text review using Covidence Systematic Review Software. Reviews addressing female-specific and obstetrics and gynecologic health of female-designated service members or veterans, utilizing a clear and systematic methodology, were eligible for inclusion. Quality assessment was conducted by teams of two reviewers. RESULTS A total of 69 studies were included in the final review. Themes included mental health and impact of sexual assault on service members or veterans, veteran health care, issues of menstruation, pregnancy, and urogenital concerns. Areas with few reviews included occupational risks of military service and impact on obstetric outcomes, eating disorders, and menopause. There were insufficient or no reviews on the impact of military service on fertility, access to abortion care, reproductive health outcomes of lesbian, bisexual and transgender service members, surgical treatment of gynecologic conditions, and screening and treatment for breast, gynecologic, and non-pelvic organ cancers. CONCLUSIONS Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.
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Affiliation(s)
- Megan C McDermott
- Department of Gynecologic Surgery & Obstetrics, Womack Army Medical Center, Ft. Liberty, NC 28310, USA
| | - Megan G Musilli
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jill E Brown
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - John L Melton
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael J Miller
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Rhonda J Allard
- Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Lovalekar M, Keenan KA, Peterson P, Cruz DE, Steele E, McFadden BA, Arent SM, Nindl BC. Neuromuscular Strength and Power Predict Musculoskeletal Injury and Attrition During Marine Corps Recruit Training. Mil Med 2024; 189:12-20. [PMID: 38920036 DOI: 10.1093/milmed/usae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Elevated rates of musculoskeletal injuries (MSIs) and attrition are documented in military recruit training. By identifying and addressing modifiable risk factors, the rate of successful training completion and military readiness can be enhanced. Despite their impact, the causes of MSIs and attrition among U.S. Marine Corps (USMC) recruits remain underexplored. This study investigates demographic, psychological, and physiological predictors of MSIs and attrition among USMC recruits. MATERIALS AND METHODS In this prospective cohort study, we evaluated USMC recruits at Marine Corps Recruit Depot, Parris Island and San Diego. Recruits were briefed and invited to volunteer. All recruits who were medically cleared to participate in recruit training were eligible to participate in the study. We gathered baseline data on potential predictors at the start of training, with follow-up data on MSIs and attrition collected post-training. Analyzed predictors encompassed dynamic and static strength measures from countermovement jumps, isometric mid-thigh pulls; and participant surveys. We employed multiple logistic regression to discern risk factors for MSI and attrition. RESULTS Our study comprised 584 USMC recruits (183 female recruits, 19.49 ± 1.88 years, 160.10 ± 7.17 cm, 61.19 ± 8.05 kg; 401 males, 18.94 ± 1.92 years, 172.97 ± 7.26 cm, 73.86 ± 11.04 kg). We observed 193 MSIs in 135 recruits, with 80.31% affecting the lower extremity (LE). Notably, lower relative peak power (odds ratio [OR] 0.91 [0.89, 0.94], P < .001) and shorter eccentric deceleration duration (OR 0.99 [0.99, 1.00], P = .005) were significant predictors of MSIs. Specifically, for LE MSIs, similar trends were noted for relative peak power and eccentric deceleration duration, with additional risks associated with lower body mass index (OR 0.93 [0.86, 0.99], P = .036) and previous LE MSIs (OR 2.25 [1.18, 4.27], P = .013). Attrition was more likely with a reduced eccentric deceleration impulse (OR 0.98 [0.97, 0.99], P < .001) and prolonged time to peak force (OR 1.36 [1.17, 1.59], P < .001) and cigarette use (OR 2.12 [1.01, 4.43], P = .046). CONCLUSIONS MSIs and attrition during USMC recruit training significantly undermine force readiness and escalate costs. Our research has pinpointed several modifiable risk factors, chiefly reduced muscular power and cigarette smoking. We advocate for neuromuscular training programs to bolster strength and power, integrated nutrition and exercise strategies for optimal body composition, and support for smoking cessation to alleviate the incidence of MSIs and curtail attrition. Initiating training with a gradual increase in activity intensity can provide a critical window to correct pre-existing neuromuscular imbalances and weaknesses, particularly those stemming from prior MSIs. Effectively addressing these risk factors is pivotal for diminishing the rates of MSIs and attrition among recruits, thereby enhancing overall military readiness and operational efficiency.
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Affiliation(s)
- Mita Lovalekar
- Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Karen A Keenan
- Exercise and Sports Science Department, Fitchburg State University, Fitchburg, MA 01420, USA
| | - Patrick Peterson
- Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Debora E Cruz
- Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Elizabeth Steele
- Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA 15203, USA
| | - Bridget A McFadden
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Shawn M Arent
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, PA 15203, USA
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Johnson CC, Dzewaltowski AC, Dever DE, Krajewski KT, Rai A, Ahamed NU, Allison KF, Flanagan SD, Graham SM, Lovalekar M, Anderst WJ, Connaboy C. Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women. Sci Rep 2024; 14:9542. [PMID: 38664550 PMCID: PMC11045865 DOI: 10.1038/s41598-024-60187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0-30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women.
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Affiliation(s)
- Camille C Johnson
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex C Dzewaltowski
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Dennis E Dever
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajinkya Rai
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katelyn F Allison
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Scott M Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA.
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Kierkegaard M, Tegern M, Halvarsson A, Broman L, Larsson H. High Physical Exposure During Female Recruits' Basic Military Training in Sweden-A Descriptive Study. Mil Med 2024; 189:e674-e682. [PMID: 37625078 PMCID: PMC10898928 DOI: 10.1093/milmed/usad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT. MATERIALS AND METHODS A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used. RESULTS The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT. CONCLUSION This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm SE-113 65, Sweden
| | - Matthias Tegern
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå SE-901 87, Sweden
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm SE-141 86, Sweden
| | - Lisbet Broman
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm SE-141 83, Sweden
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Edwards CM, da Silva DF, Puranda JL, Souza SCS, Semeniuk K, Adamo KB. Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test. J Strength Cond Res 2024; 38:367-373. [PMID: 37815270 DOI: 10.1519/jsc.0000000000004606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.
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Affiliation(s)
- Chris Margaret Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Danilo Fernandes da Silva
- Sports Studies Department, Faculty of Arts and Science, Bishop's University, Sherbrooke, Quebec, Canada
| | - Jessica Laura Puranda
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; and
| | | | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Kristi Bree Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; and
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Pontillo M, Mazzone Gunterstockman B, Bunn A, Bechard L, Wolfgramm S, Mack T, Farrokhi S. Foot Strike Run Retraining for Patients With Patellofemoral Chondral Defects: A Case Series. Mil Med 2024; 189:384-390. [PMID: 37930763 DOI: 10.1093/milmed/usad413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/24/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Military service members (SMs) demonstrate high rates of patellofemoral chondral defects (PFCDs) that are difficult to diagnosis and, if untreated, result in a cascade of events eventually leading to osteoarthritis. Running is an essential occupational task for SMs; however, there is little evidence regarding techniques to maintain running ability in individuals with cartilage defects. The purpose of this case series was to assess the clinical application of foot strike run retraining in patients with PFCDs. This case series included two active duty U.S. Marine Corps SMs who presented to outpatient physical therapy with PFCD, diagnosed via MRI. Both patients attended eight foot strike run retraining sessions. Running mechanics and patient-reported outcomes were recorded pre-training, post-training, and at a 1-month follow-up visit. Both patients successfully converted their strike pattern from a rearfoot to a non-rearfoot strike pattern with training and retained this strategy at 1-month follow-up. Post-intervention, both patients demonstrated increased running tolerance, and improvements in Numeric Pain Rating Scale and Lower Extremity Functional Scale scores. Biomechanical analysis showed that both patients demonstrated a 63% to 70% reduction in average and peak vertical ground reaction force loading rates post-treatment. Modification of foot strike pattern from rear to non-rearfoot strike during running for individuals with PFCD can reduce the magnitude of impact loading, which potentially limits disease progression. These findings suggest that foot strike run retraining may be a feasible strategy to reduce pain and improve function in SMs with PFCD who are required to run for occupational responsibilities.
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Affiliation(s)
- Marisa Pontillo
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | | | - Adam Bunn
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Laura Bechard
- Department of Physical and Occupational Therapy, Naval Hospital Pensacola, Pensacola, FL 32512, USA
| | - Sione Wolfgramm
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Takman Mack
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Shawn Farrokhi
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Cialdella-Kam L, Bloedon TK, Stone MS. Body composition as a marker of performance and health in military personnel. Front Sports Act Living 2023; 5:1223254. [PMID: 38169866 PMCID: PMC10759214 DOI: 10.3389/fspor.2023.1223254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Body composition standards are set to ensure operational readiness in active-duty military personnel. To meet body composition standards, some individuals, however, may engage in unhealthy weight control behaviors (i.e., weight cycling and disordered eating). The objectives of this review are to: (1) evaluate the evidence regarding body composition and the associations to physical and military specific performance; (2) discuss body composition and potential health consequences; and (3) examine the evidence of weight cycling and disordered eating behaviors in military personnel for weight control. Methods A systematic search to identify peer-reviewed research articles was conducted in PubMed on 2/20/2023 using Medical Subject Headings (MeSH) including but not limited to "Military Personnel", "Tactical Athlete", "Weight Loss", "Body Composition", and "Weight Cycling". Results A total of 225 research articles were identified. The list was narrowed down to articles from the last 20 years (2003-2023) in military personnel. Only studies in which percent body fat was directly measured were included resulting in 17 research articles for this review. Discussion Evidence-based research is limited on the relationship between body composition and operational readiness. Weight cycling and disordered eating behaviors also has been reported for weight control, yet additional research is needed. Specifically, future research should focus on female service members, racial and ethnic differences, age, and postpartum status and include other service branches (i.e., Air Force and Navy). A comprehensive survey on weight cycling, disordered eating, and weight management would be valuable to determine the prevalence and extent of this issue. This information along with performance data would guide policy makers on the relevance and appropriateness of existing body composition standards.
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Affiliation(s)
- Lynn Cialdella-Kam
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, United States
| | - Taylor K. Bloedon
- School of Applied Health, Cal Poly Humboldt, Arcata, CA, United States
| | - Michael S. Stone
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, United States
- Military and Veterans Health Solutions, Leidos, San Diego, CA, United States
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Rhon DI, Plisky PJ, Kiesel K, Greenlee TA, Bullock GS, Shaffer SW, Goffar SL, Teyhen DS. Predicting Subsequent Injury after Being Cleared to Return to Work from Initial Lumbar or Lower Extremity Injury. Med Sci Sports Exerc 2023; 55:2115-2122. [PMID: 37486770 DOI: 10.1249/mss.0000000000003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE The purpose of this study is to develop a model to predict re-injury after being cleared to return to full duty from an initial injury. METHODS This was a prediction model derivation cohort study. Military service members cleared for unrestricted full duty after sustaining a musculoskeletal injury were enrolled from three large military hospitals. Medical history, demographics, psychological profile, physical performance (Y-Balance Test™, Functional Movement Screen™, Selective Functional Movement Assessment, triple hop, closed chain ankle dorsiflexion, 2-mile run, 75% bodyweight carry time), and past injury history were assessed. Monthly text messages, medical records and limited duty databases were used to identify injuries resulting in time lost from work in the following year. RESULTS Four hundred fifty participants (65 females), ages 18 to 45 yr were analyzed. Fifteen variables were included in the final model. The area under the curve was 0.74 (95% confidence interval, 0.69-0.80), indicating good performance. The calibration score of the model was 1.05 (95% confidence interval, 0.80-1.30) indicating very good performance. With an injury incidence in our cohort of 38.0%, the treat all net benefit was 0.000, and the net benefit of our predictive model was 0.251. This means 25 additional soldiers out of every 100 were correctly identified as high risk for injury compared with not using a prediction model at all. CONCLUSIONS This multivariable model accurately predicted injury risk after returning for full duty and was better than not using a prediction model at all (an additional 25 of every 100 tactical athletes were correctly identified). This model provides guidance for proper decision making about when these individuals are not ready to return to full duty, with higher risk of a subsequent injury.
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Affiliation(s)
| | - Phillip J Plisky
- Department of Physical Therapy, University of Evansville, Evansville, IN
| | - Kyle Kiesel
- Department of Physical Therapy, University of Evansville, Evansville, IN
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX
| | | | - Scott W Shaffer
- School of Physical Therapy, University of Incarnate Word, San Antonio, TX
| | - Stephen L Goffar
- School of Physical Therapy, University of Incarnate Word, San Antonio, TX
| | - Deydre S Teyhen
- 20 Chief, Army Medical Specialist Corps, Fort Sam Houston, TX, USA
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Gwilliam M, Hendricks S, Socias-Morales C, Burnham B, Gomes H, Reichard A, Stallings H. Comparison of Finger, Hand, and Wrist Injuries in the US Air Force to US Workers. J Occup Environ Med 2023; 65:663-669. [PMID: 37072928 PMCID: PMC10523846 DOI: 10.1097/jom.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Fingers, hands, and wrists (FHW) are the most frequently injured body parts in work-related injuries. This study described and compared FHW injuries among enlisted, officer, and civilian US Air Force (USAF) personnel to those in the US workforce. METHODS All work-related, noncombat FHW injuries (≥1 lost workday) and demographics among USAF personnel and US workforce (2008-2018) were included. The USAF FHW injury rates were age adjusted to the US employment and compared by sex, source, event, and nature of the injuries. RESULTS Finger, hand, and wrist injuries were significantly lower among the USAF personnel and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment. CONCLUSIONS Prevention efforts should focus on understanding risk factors and sharing successful prevention activities.
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O'Leary TJ, Coombs CV, Perrett C, Double RL, Keay N, Wardle SL, Greeves JP. Menstrual Function, Eating Disorders, Low Energy Availability, and Musculoskeletal Injuries in British Servicewomen. Med Sci Sports Exerc 2023; 55:1307-1316. [PMID: 36893306 DOI: 10.1249/mss.0000000000003154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. METHODS All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. RESULTS A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67-3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21-2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07-6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66-2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90-11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84-5.04); P < 0.001) than women at low risk of low energy availability. CONCLUSIONS Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen.
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Affiliation(s)
| | - Charlotte V Coombs
- Army Health and Performance Research, Army Headquarters, Andover, UNITED KINGDOM
| | - Caitlin Perrett
- Division of Surgery and Interventional Science, UCL, London, UNITED KINGDOM
| | - Rebecca L Double
- Army Health and Performance Research, Army Headquarters, Andover, UNITED KINGDOM
| | - Nicky Keay
- Division of Medicine, UCL, London, UNITED KINGDOM
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11
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Roach MH, Bird MB, Helton MS, Mauntel TC. Musculoskeletal Injury Risk Stratification: A Traffic Light System for Military Service Members. Healthcare (Basel) 2023; 11:1675. [PMID: 37372795 DOI: 10.3390/healthcare11121675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Risk factor identification is a critical first step in informing musculoskeletal injury (MSKI) risk mitigation strategies. This investigation aimed to determine if a self-reported MSKI risk assessment can accurately identify military service members at greater MSKI risk and determine whether a traffic light model can differentiate service members' MSKI risks. A retrospective cohort study was conducted using existing self-reported MSKI risk assessment data and MSKI data from the Military Health System. A total of 2520 military service members (2219 males: age 23.49 ± 5.17 y, BMI 25.11 ± 2.94 kg/m2; and 301 females: age 24.23 ± 5.85 y, BMI 25.59 ± 3.20 kg/m2, respectively) completed the MSKI risk assessment during in-processing. The risk assessment consisted of 16 self-report items regarding demographics, general health, physical fitness, and pain experienced during movement screens. These 16 data points were converted to 11 variables of interest. For each variable, service members were dichotomized as at risk or not at risk. Nine of the 11 variables were associated with a greater MSKI risk and were thus considered as risk factors for the traffic light model. Each traffic light model included three color codes (i.e., green, amber, and red) to designate risk (i.e., low, moderate, and high). Four traffic light models were generated to examine the risk and overall precision of different cut-off values for the amber and red categories. In all four models, service members categorized as amber [hazard ratio (HR) = 1.38-1.70] or red (HR = 2.67-5.82) were at a greater MSKI risk. The traffic light model may help prioritize service members who require individualized orthopedic care and MSKI risk mitigation plans.
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Affiliation(s)
- Megan H Roach
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22041, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | - Matthew B Bird
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22041, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Liberty, NC 28310, USA
| | | | - Timothy C Mauntel
- Extremity Trauma & Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22041, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Clinical Investigations, Womack Army Medical Center, Fort Liberty, NC 28310, USA
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12
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Ritland BM, Judkins JL, Naylor JA, Kardouni JR, Pasiakos SM, Jayne JM. The relationship between sleep, pain,and musculoskeletal injuries in US Army Soldiers. BMJ Mil Health 2023:e002281. [PMID: 36792225 DOI: 10.1136/military-2022-002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/27/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship between sleep and pain in military personnel and to determine if metrics of sleep and pain intensity differ between the injured and uninjured in this population. METHODS Active-duty US Army Soldiers (n=308; 26.8±6.5 years, 82% male) from the 2nd Infantry Division, Joint Base Lewis-McChord, Washington, and 101st Airborne Division, Fort Campbell, Kentucky, completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and questionnaires about current musculoskeletal injuries and pain intensity (0=no pain to 10=worst imaginable pain). Pearson correlation coefficients were used to assess the association between pain and sleep. Differences in sleep and pain between injured and uninjured participants were determined using an analysis of covariance. RESULTS Pain intensity was positively correlated with sleep quality (global PSQI score, r=0.337, p<0.001) and daytime sleepiness (ESS score, r=0.163, p=0.005), and negatively associated with sleep duration (r=-0.118, p=0.039). Injured participants accounted for 37.7% (n=116) of the study population. Injured participants reported greater pain intensity (3.7±2.5 vs 1.3±1.9, p<0.001), were older (28.5±7.4 years vs 25.8±5.7 years, p=0.001) and in the service longer (6.3±6.3 years vs 4.6±4.7 years, p=0.013) than uninjured participants. Injured participants had higher global PSQI scores (9.0±4.1 vs 6.4±3.4, p<0.001), including each of the seven PSQI components (all p<0.050), and reported sleeping less per night than uninjured participants (5.7±1.3 hours vs 6.1±1.2 hours, p=0.026). CONCLUSION These data demonstrate that pain intensity is associated with sleep in active-duty US Army Soldiers and that those who report a musculoskeletal injury, regardless of age and time in service, report poorer sleep quality, shorter sleep durations, and greater levels of pain than uninjured Soldiers.
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Affiliation(s)
- Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, 01760, USA
| | - J L Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, 01760, USA
| | - J A Naylor
- US Army Forces Command, Tacoma, Washington, 98433, USA
| | - J R Kardouni
- US Army Forces Command, Fort Bragg, North Carolina, 28310, USA
| | - S M Pasiakos
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, 01760, USA
| | - J M Jayne
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, 01760, USA
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13
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Musculoskeletal Injury Risk in a Military Cadet Population Participating in an Injury-Prevention Program. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020356. [PMID: 36837558 PMCID: PMC9961050 DOI: 10.3390/medicina59020356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected.
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14
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Ali AM, Alam MM, Sufyaan M, Ahmad I, Zarrin S. Prevalence of work-related musculoskeletal disorders among professional rickshaw drivers in Aligarh, Uttar Pradesh, India. Work 2023; 76:1239-1253. [PMID: 37182856 DOI: 10.3233/wor-220621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Professional rickshaw driving is a seemingly sedentary occupation and involves many risk factors for work-related musculoskeletal disorders (WMSD). OBJECTIVE To assess the prevalence of work-related musculoskeletal disorders and its associated risk factors among professional rickshaw drivers. METHODS 263 rickshaw drivers were voluntarily recruited from Aligarh, Uttar Pradesh, India. MSD symptoms in the past 12 months and last 7 days were assessed using a self-modified musculoskeletal questionnaire (Nordic Questionnaire). Chi-square tests and binary logistic regression were performed to analyze associations of MSD symptoms between study variables. RESULTS 155 (58.9%) study participants reported MSD symptoms in past 12 months, in lower back (n = 126, 81.3%), leg (n = 122, 78.7%), neck (n = 106, 68.4%) and knee (n = 105, 67.7%); and 121 (46.1%) in last 7 days, in leg (n = 107, 88.4%), lower back (n = 102, 84.3%), neck (n = 89, 73.6%), upper back and knees (n = 87, 71.9%). Binary logistic regression showed relationship between working hours, seat and road condition, average load per ride, rickshaw ride duration, and standing driving with MSD symptoms among rickshaw drivers, especially in the lower back, leg/calf muscles, neck and knees. CONCLUSION The results showed a high prevalence of MSD among all rickshaw drivers, with the neck, lower back, leg/calf muscles and knees being the most affected body parts. In order to avoid adverse effects on the occupational health of rickshaw drivers, ergonomic intervention training is necessary.
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Affiliation(s)
- Abdulelah M Ali
- Department of Industrial Engineering, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mohd Mukhtar Alam
- Department of Industrial Engineering, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohd Sufyaan
- Department of Mechanical Engineering, Faculty of Engineering and Technology, Aligarh Muslim University, Aligarh, India
| | - Israr Ahmad
- Department of Mechanical Engineering, Faculty of Engineering and Technology, Aligarh Muslim University, Aligarh, India
| | - Saima Zarrin
- Department of Statistics and Operations Research, Aligarh Muslim University, Aligarh, India
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15
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Chang TT, Yang QH, Chen PJ, Wang XQ. Epidemiology of Musculoskeletal Injuries in the Navy: A Systematic Review. Int J Public Health 2022; 67:1605435. [PMID: 36531604 PMCID: PMC9751041 DOI: 10.3389/ijph.2022.1605435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aimed to critically review the results of recent studies that investigated the epidemiology of noncombat-related musculoskeletal injuries (MSIs) in the Navy. Methods: A systematic search was conducted of three major databases (Pubmed, Embase, and Cochrane) to identify epidemiological studies on MSIs in the Navy. Study selection and risk of bias assessment were conducted. Results: The overall prevalence of MSIs ranged from 12.69% to 48.81%. And the prevalence of head and face injuries, upper extremity injuries, spine injuries, chest injuries, and lower extremity injuries were 0.11%-0.66%, 0.53%-11.47%, 0.75%-12.09%, 0.43%-0.95%, and 0.4%-21.17%, respectively. For the specific MSIs, the incidence ranged from 0.03/1000 person-years to 32.3/1000 person-years in the Navy and Marines. The ankle-foot, lumbopelvic, knee and lower leg, and shoulder were identified as the most frequent location for MSIs. Conclusion: This systematic review summarized that the Navy population had a high prevalence of MSIs. And different risk factors for MSIs varied from different anatomic locations. This systematic review also provided valuable information on MSIs for sports medicine specialists.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China,Shanghai Key Lab of Human Performance, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
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16
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Maupin D, Schram B, Canetti EFD, Dulla JM, Dawes JJ, Lockie RG, Orr RM. Profiling the Typical Training Load of a Law Enforcement Recruit Class. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13457. [PMID: 36294036 PMCID: PMC9603164 DOI: 10.3390/ijerph192013457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Law enforcement academies, designed to prepare recruits for their prospective career, represent periods of high physical and mental stress, potentially contributing to recruits' injuries. Managing stress via monitoring training loads may mitigate injuries while ensuring adequate preparation. However, it is vital to first understand an academy's typical training load. The aim of this study was to profile the typical training load of law enforcement recruits over the course of 22 weeks. Data were prospectively collected using global positioning system (GPS) units placed on recruits during a portion of the academy training, while a desktop analysis was retrospectively applied to six other classes. A Bland-Altman plot was conducted to assess the agreement between the two methods. A linear mixed model was conducted to analyse the difference in distances covered per week, while other variables were presented graphically. Adequate agreement between the desktop analysis and GPS units was observed. Significant differences (p-value < 0.01) in distance covered (9.64 to 11.65 km) exist between weeks during early academy stages, which coincide with increases (~6 h) in physical training. Significant decreases in distances were experienced during the last five weeks of academy training. Most acute:chronic workload ratios stayed between the proposed 0.8 to 1.3 optimal range. Results from this study indicate that large increases in training occur early in the academy, potentially influencing injuries. Utilizing a desktop analysis is a pragmatic and reliable approach for instructors to measure load.
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Affiliation(s)
- Danny Maupin
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Ben Schram
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
- Tactical Research Unit, Bond University, Gold Coast, QLD 4226, Australia
| | - Elisa F. D. Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
- Tactical Research Unit, Bond University, Gold Coast, QLD 4226, Australia
| | - Joseph M. Dulla
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - J. Jay Dawes
- Tactical Research Unit, Bond University, Gold Coast, QLD 4226, Australia
- School of Kinesiology, Oklahoma States University, Stillwater, OK 74078, USA
| | - Robert G. Lockie
- Tactical Research Unit, Bond University, Gold Coast, QLD 4226, Australia
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
| | - Robin M. Orr
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4226, Australia
- Tactical Research Unit, Bond University, Gold Coast, QLD 4226, Australia
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17
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Campbell P, Pope R, Simas V, Canetti E, Schram B, Orr R. The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13416. [PMID: 36293997 PMCID: PMC9602812 DOI: 10.3390/ijerph192013416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
The risks and incidence rates of musculoskeletal injuries among military personnel are high, and the importance of physiotherapy in treating these injuries is well established. However, what is less clear is whether the timing of commencement of physiotherapy treatment affects musculoskeletal injury outcomes in military personnel. This lack of clarity is exacerbated by the known underreporting of injuries among military personnel, and the resulting self-management of musculoskeletal injuries using analgesics, non-steroidal anti-inflammatories and other means. This narrative review was designed to identify and synthesize current evidence regarding the effects of timing of physiotherapy treatment on musculoskeletal injury outcomes, focusing on potential benefits of early versus typical or delayed commencement of physiotherapy treatment. Overall, current evidence suggests early physiotherapy treatment of musculoskeletal injuries offers distinct advantages over typical or delayed commencement of physiotherapy treatment in military settings. Specifically, it appears early treatment expedites recovery in early phases following injury onset and benefits longer term mental health and well-being. It may also reduce the need for more invasive and costly health care interventions and enable earlier return to training and operational service. Importantly, a cultural shift within military contexts to ensure early reporting of musculoskeletal injuries is required if the benefits of early commencement of physiotherapy treatment are to be achieved.
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Affiliation(s)
- Patrick Campbell
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
| | - Rodney Pope
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, NSW 2640, Australia
| | - Vinicius Simas
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
| | - Elisa Canetti
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Benjamin Schram
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, QLD 4229, Australia
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4229, Australia
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18
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Lisman P, Ritland BM, Burke TM, Sweeney L, Dobrosielski DA. The Association Between Sleep and Musculoskeletal Injuries in Military Personnel: A Systematic Review. Mil Med 2022; 187:1318-1329. [PMID: 35544342 DOI: 10.1093/milmed/usac118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKIs) are a significant health problem in the military. Accordingly, identifying risk factors associated with MSKI to develop targeted strategies that attenuate injury risk remains a top priority within the military. Insufficient sleep has garnered increased attention as a potential risk factor for MSKI in both civilians and military personnel. Yet, there are no systematic evaluations of the potential association between sleep and MSKI in the military. The purpose of this review is to examine the relationship between sleep and injury in military personnel. MATERIALS AND METHODS Literature searches were performed in multiple electronic databases using keywords relevant to sleep quantity and quality, MSKI, and military populations. Two investigators independently assessed the methodological quality of each study using the Newcastle-Ottawa Scale for cohort studies or an adapted form of this scale for cross-sectional studies. RESULTS The search yielded 2402 total citations, with 8 studies (3 cohort and 5 cross-sectional) fitting the inclusion criteria. Overall, the systematic review found 5 of the 8 reviewed studies supporting an association between sleep (quality and duration) and MSKI in military personnel. Specifically, poor sleep was associated with increased injury incidence in 2 cohort and 3 cross-sectional studies. CONCLUSION This is the first systematic review to evaluate the published literature on the association between sleep and MSKI risk in military populations. Although there is currently limited research on this topic, findings suggest that sleep is associated with MSKI and should be considered when designing strategies aimed at reducing MSKI risk in military personnel.
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Affiliation(s)
- Peter Lisman
- Department of Kinesiology, Towson University, Towson, MD 21252, USA.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD 21252, USA
| | - Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tina M Burke
- Behavior Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Lisa Sweeney
- Department of Library Services, Towson University, Towson, MD 21252, USA
| | - Devon A Dobrosielski
- Department of Kinesiology, Towson University, Towson, MD 21252, USA.,Towson Research Academy of Collaborative Sport Science (TRACS), Towson University, Towson, MD 21252, USA
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19
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Kierkegaard M, Tegern M, Broman L, Halvarsson A, Larsson H. Test-Retest Reliability and Translation of the Musculoskeletal Screening Protocol Questionnaire Used in the Swedish Armed Forces. Mil Med 2022; 188:usac082. [PMID: 35365829 PMCID: PMC10362998 DOI: 10.1093/milmed/usac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Musculoskeletal disorders (MSDs) in military personnel are common, and it is important to identify those at risk so that appropriate preventive and rehabilitative strategies can be undertaken. The Musculoskeletal Screening Protocol (MSP) questionnaire is part of the implemented prevention strategy to reduce MSDs in the Swedish Armed Forces. The aims of this study were to evaluate the questionnaire's reliability and to translate it into English. MATERIALS AND METHODS One-week test-retest reliability of the questionnaire was evaluated in a sample of 35 Swedish military personnel. Reliability was evaluated by calculations of Cohen's kappa or quadratic-weighted kappa. Percent agreement was used as a parameter for measurement error. Translation into English included forward and backward translations and expert committee discussions. RESULTS Kappa values relating to physical complaints/injuries were excellent (>0.75) except for knee and lower leg MSDs and for the intensity ratings, where Kappa values were mostly interpreted as fair-to-good (0.4-0.75). Kappa values of items pertaining physical performance, physical activity and exercise, eating and tobacco habits, sleep, and perceived health ranged between 0.72 and 1. Kappa values for feeling mentally or physical prepared were 0.47 and 0.65, respectively. Most percentage agreement values ranged between 90% and 100%. The English version was found to be satisfactorily equivalent to the Swedish MSP questionnaire. CONCLUSION The Swedish MSP questionnaire was found to be highly reliable and was satisfactorily translated into English. This provides support for the questionnaire's ability to trustworthily capture the prevalence of MSDs and perceived health in military personnel. Future research is warranted on the psychometric properties of the English MSP questionnaire.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm 141 86, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm 113 65, Sweden
| | - Matthias Tegern
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Department of Community Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå 901 87, Sweden
| | - Lisbet Broman
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Stockholm 141 86, Sweden
| | - Helena Larsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm 141 83, Sweden
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20
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Das D, Singh AK. Risk factors associated with work-related musculoskeletal disorders among floor-sitting precision handicraft workers. Int Arch Occup Environ Health 2021; 95:1129-1145. [PMID: 34817669 DOI: 10.1007/s00420-021-01817-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Precision handicraft workers are often exposed to stressful postures and poor working conditions while performing different jobs, that are directly associated with the development of musculoskeletal disorders (MSDs). This cross-sectional study aimed at evaluating the prevalence of MSDs and contributing risk factors among male precision handicraft workers. METHODS 334 handicraft workers involved in different precision activities: 125 gemstone cutters, 98 miniature painters, and 111 metal craft workers, were surveyed. Information about the prevalence of musculoskeletal symptoms and work-related factors was collected using the self-reported questionnaire and direct observation methods, viz. rapid upper limb assessment (RULA) and rapid entire body assessment (REBA). Chi-square test was performed to analyze the association of MSD symptoms between the handicraft occupations. Further, binary logistic regression was used to identify the potential risk factors for MSD symptoms among workers. RESULTS In all occupational groups, most participants reported high prevalence of MSDs primarily in the neck (61.6%), lower back (74.8%), and knee (54.7%) regions. Results revealed that age, work experience, prolonged work hours, sustained awkward posture, continuous work without break, extensive work pressure, and poor job control increased the risk of MSD symptoms in different body regions, while with a higher level of education, MSDs in the neck and lower back regions reduced. CONCLUSION The findings indicated incompatibility between precision handicraft workers and the occupational environment. Logistic regression models showed significant contribution of physical and psychosocial work-related factors in developing MSD symptoms. Ergonomic interventions are imperative to evade adverse consequences on the occupational health of precision craft workers.
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Affiliation(s)
- Dipayan Das
- Department of Mechanical Engineering, National Institute of Technology Sikkim, Sikkim, India
| | - Ashish Kumar Singh
- Department of Mechanical Engineering, National Institute of Technology Sikkim, Sikkim, India. .,School of Design, Vellore Institute of Technology, Vellore, Tamil Nadu, India.
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