Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 27;29(6):461-473.
doi: 10.1136/ip-2023-044905.

Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review

Garrett S Bullock  1   2 , Carolyn E Dartt  3   4 , Emily A Ricker  3   4 , Joanne L Fallowfield  5 , Nigel Arden  6   7 , Daniel Clifton  3   4 , Kerry Danelson  1 , John J Fraser  8 , Christina Gomez  9 , Tina A Greenlee  10 , Alexandria Gregory  3   4 , Timothy Gribbin  3   4 , Justin Losciale  11   12 , Joseph M Molloy  13 , Kristen F Nicholson  1 , Julia-Grace Polich  1 , Anu Räisänen  14   15 , Karishma Shah  6 , Michael Smuda  3   4 , Deydre S Teyhen  16 , Rhonda J Allard  17 , Gary S Collins  18 , Sarah J de la Motte #  19 , Daniel I Rhon #  20   21
Affiliations

Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review

Garrett S Bullock et al. Inj Prev. .

Abstract

Introduction: Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities.

Methods: A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified.

Results: From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions.

Conclusion: Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military.

Keywords: community; implementation / translation; military; systematic review.

PubMed Disclaimer

Conflict of interest statement

Competing interests: NA reports grants from Centre for Sport, Exercise & Osteoarthritis Research Versus Arthritis, outside of the submitted work. SdlM reports grants from the Congressionally Directed Medical Research Programme and the Veterans Affairs/Department of Defense Health Affairs Joint Incentive Fund, outside of the submitted work. JJF reports grants from Congressionally Directed Medical Research Programme and the Office of Naval Research, outside of the submitted work. In addition, JJF has a patent pending for an Adaptive and Variable Stiffness Ankle Brace, US Provisional Patent Application No. 63254,474. AR reports grants from the Concussion in Sport Group, Alberta Bone and Joint Strategic Clinical Network, Tonal Strength Institute, outside of the submitted work. DIR reports grants from the Congressionally Directed Medical Research Programme and the National Institutes of Health, outside of the submitted work, and grant support for the submitted work from the Uniformed Services University, Department of Physical Medicine & Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness programme (MIRROR HU00011920011).

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. CINAHL, Cumulated Index to Nursing and Allied Health Literature; DTIC, Defense Technical Information Center; MEDLINE, US National Library of Medicine bibliographic database.
Figure 2
Figure 2
Publication rates by 5-year period and military branch.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Jones BH, Canham-Chervak M, Canada S, et al. . Medical surveillance of injuries in the US military: descriptive epidemiology and recommendations for improvement. Am J Prev Med 2010;38:S42–60. 10.1016/j.amepre.2009.10.014 - DOI - PubMed
    1. Lovalekar M, Hauret K, Roy T, et al. . Musculoskeletal injuries in military personnel-descriptive epidemiology, risk factor identification, and prevention. J Sci Med Sport 2021;24:963–9. 10.1016/j.jsams.2021.03.016 - DOI - PubMed
    1. Rudzki SJ. Injuries in Australian army recruits. Part I: decreased incidence and severity of injury seen with reduced running distance. Mil Med 1997;162:472–6. 10.1093/milmed/162.7.472 - DOI - PubMed
    1. Heir T, Glomsaker P. Epidemiology of musculoskeletal injuries among Norwegian conscripts undergoing basic military training. Scand J Med Sci Sports 1996;6:186–91. 10.1111/j.1600-0838.1996.tb00088.x - DOI - PubMed
    1. Fenn BP, Song J, Casey J, et al. . Worldwide epidemiology of foot and ankle injuries during military training: a systematic review. BMJ Mil Health 2021;167:131–6. 10.1136/bmjmilitary-2020-001591 - DOI - PubMed

Publication types