Screening for Musculoskeletal Injury (#1 Defense HealthCare Burden)

It is an annual requirement to screen every Service member for hearing, vision, dental, and overall health wellness. We also routinely screen for other medical conditions (HIV) and mental health. However, we don’t screen for musculoskeletal injuries, which are the primary source of disability in the U.S. Military. They affect over 900,000 service members annually; resulting in over 25 million limited-duty days. In 2007 alone they were responsible for approximately 2.4 million medical visits to military treatment facilities and accounted for $548 million dollars in direct patient care costs. These injuries decimate our units at a much faster pace than any combat-related injuries, and the associated disability long carries over into retirement and separation.

Risk factors predisposing individuals to injury are well known and many are modifiable. We are proposing a novel approach for screening and predicting injury risk in our Service Member. The screening criteria are based on field expedient, evidence based screening tools that have been successful in identifying injury risk in athletic populations (professional and collegiate athletes) but have yet to be validated for use in the military setting or across different military occupational specialties. These novel screening tools will assess fundamental movement, dynamic balance, upper extremity & trunk stability, and biopsychosocial factors in addition to common injury predictors (sex, prior history of injury, fitness level, smoking, etc) that are central to predicting and reducing injury in the military. Using these tests, researchers on our team have developed computerized algorithms for athletes that stratify injury risk level, identify need for medical referral, and provide injury mitigation strategies. These tools are currently being combined for injury assessment of athletes at the high school, university, and professional levels. A field-expedient multi-factorial approach, as we are proposing, has the potential to increase the specificity of predicting future injury by addressing multiple evidence-based risk factors that is conducive to the military setting. Based on preliminary research, we expect that these risk factors will be predictive of injury within and across different military specialties. We recently evaluated these in 1,500 Soldiers to include Rangers, Special Forces and Soldiers in a Brigade Combat Team and prospectively followed them for one year to identify injuries. We are in the process of identifying the most parsimonious set of risk factors that identify an individual Soldier’s injury risk; which will likely vary across military specialty. Once individual risk is identified, appropriate injury mitigation strategies can be implemented to reduce an individual’s injury risk and ultimately reduce time lost due to musculoskeletal injury. The potential value is in harnessing the ability to predict which of our Service Members are more likely to sustain a musculoskeletal injury before it even happens, the extent of the injury, and intervene appropriately before this occurs. Many of the potential risk factors are modifiable, meaning that appropriate intervention has the potential to go a long way in reducing the risk of injury. Performed annually, Service Members would have a documented trail of their change in risk throughout their time in the service, receive personalized reports with action plans, and commanders could receive unit reports about the risk of injury for every single member of their organization. There are many implications to include specificity of training, assessment at basic training and entrance in the military, etc.

We are proposing the use of an injury risk screening protocol (we've piloted on 1500 Soldiers. Each Service Member will get a personalized report, an injury risk stratification score (1-5), and action plan which includes a direct referral to a specialist if they are in the highest risk injury group (exercise prescription, smoking cessation, mental health, etc). Their PCM will be able to track their risk status in their medical records in the same manner that they track any other common variables, such as cardiovascular risk factors, etc. We propose to pilot this in the US Army, but it can easily become a DoD tri-service integration solution across other services.

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