Isaacson B, Wagner L, West S, Lucio W, Yuan X, Hager N, Pasquina P

Abstract submitted to Military Health System Research Symposium 2022.

Musculoskeletal injuries (MSI) affect approximately 800,000 Service Members annually and result in 25 million limited duty days. These conditions are the primary reasons for medical discharge and downgrade, and result in 34% of evacuations from theatre. Most concerning is that the disability discharge rate for MSI has increased 13x between 1981 and 2005 (70 vs. 950 per 100,000 persons). The alarming increase of MSI has also been observed in the general population, with an estimated 126.6 million Americans (one in every two adults) affected by a musculoskeletal condition — comparable to the total percentage of Americans living with a chronic lung or heart condition and costing an estimated $213 billion. Given the strict requirements for physical fitness in the military and the impact of MSI on combat readiness, the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) organization was established in 2019 to advance the treatment and preventive care for Service Members with non-combat related MSI. MIRROR coordinates inter-service partnerships with premier academic institutions, primary military treatment facilities (MTFs), and civilian sites that experience a high volume of MSI, but lack a robust infrastructure to conduct rigorous trials. MIRROR is based in the Department of Physical Medicine & Rehabilitation at the Uniformed Services University and closely aligns with the Defense Health Agency (DHA), Department of Defense (DoD) leadership, Joint Program Committee (JPC) chairs, and other high-level advisory groups. In addition, our Steering Committee, comprised of nationally-renowned military and civilian subject matter experts in various musculoskeletal subspecialties, provides guidance and oversight on MIRROR’s direction, scope, and overall methods. The MIRROR organization also incorporates select MSI sub-portfolios (i.e., orthopedics, interventional spine and pain management, physical and occupational therapy), under the direction of subject matter experts, to further advance our mission across all MSI research areas. Our representation across both operational leadership and research subspecialties allows MIRROR to maximize its impact throughout the MHS. To ensure that findings are clinically translational, data is collected using standardized protocol content, case report forms, and recruitment/outcomes captured through REDCap. Real-time feedback is provided using PowerBI to ensure that data can be presented in a highly efficient manger without the risk of protected health information (PHI) disclosure. This allows quick assessment of key performance indicators and provides useful data to understand healthcare disparities.

Greenlee T, Bullock G, Teyhen D, Rhon D

Abstract submitted to Military Health System Research Symposium 2022.

Prevalence and burden of musculoskeletal injuries for military service members are high, with recurrent injuries contributing to greater costs, more time lost from duty, and sub-optimal force readiness. Several psychological factors are associated with injury and return to work readiness in sport and occupational settings. We explored whether the psychological state of soldiers returning to duty following an injury could predict time-loss injury within the next year. We performed a secondary analysis of data from a longitudinal cohort study of soldiers returning to full duty after a recent thoracolumbar spine (TLS) or lower extremity (LE) injury after seeking medical care. A psychological profile (depression, anxiety, anger, fear, frustration, exercise enjoyment, job-, military-, and life-satisfaction, kinesiophobia, fear avoidance beliefs, pain catastrophizing, stress, and mood) was assessed via self-report at the point of initial return-to-duty and Soldiers were followed for one year.

Foster K, Greenlee T, Fraser J, Young J, Rhon D

Abstract submitted to Military Health System Symposium 2022

One in every four individuals with an ankle sprain went on to have a proximal joint injury in the following year, knee and lumbar spine diagnoses occurring more frequently than hip. Associated fracture with the initial ankle sprain increased the odds of sustaining a subsequent hip or lumbar spine injury. Further, females had higher risk of developing subsequent hip or lumbar spine injuries after ankle sprain whereas males were more likely to develop subsequent knee issues. Less than half of the cohort received rehabilitation following an ankle sprain, but exercise therapy was found to be preventative of secondary injuries to the knee, hip, and lumbar spine. While these associations are often discussed by clinicians, the increased understanding of prevalence of proximal joint disorders has the potential to help guide treatment and inform decisions related to returning to work and sport, improving the care for patients and decreasing the physical and financial toll of this common injury.