Rhon D, de la motte S, Fraser J, hando b, Molloy J, Teyhen D, Tiede J, Van Wyngaarden J, Westrick R, Bullock G

Abstract accepted for ePoster at the 2024 IOC World Conference on Prevention of Injury and Illness in Sport

Injuries are the primary cause of lost duty in the US Military, leading to a widespread focus on, and implementation of injury mitigation programs. The effectiveness of these programs is often questioned, usually related to program fidelity. The objective of this cross-sectional survey study was to identify and characterize barriers and facilitators for implementing injury mitigation programs in the military.

While most stakeholders agree that injury mitigation programs are important, there appears to be a perceived disconnect between the tasks and training associated with operational readiness and the implementation of injury prevention programs.

crowell ms, brindle ra, miller em, reilly n, ford kr, goss dl

Running is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury.

Crowell, M.S., Brindle, R.A., Miller, E.M. et al. The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial. Trials 24, 672 (2023). https://doi.org/10.1186/s13063-023-07502-x

Cohen S, larkin t, weitzner a, dolomisiewicz e, wang e, hsu a, anderson-white m, smith m, zhao z

There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical non-steroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics.

For the primary outcome, the median reduction in average neck pain score was -1.0 (IQR -2.0, 0.0) for the lidocaine phase vs. -0.5 (IQR -2.0,.0) for placebo treatment (p=0.17). 27.7% of patients experienced a positive outcome during lidocaine treatment vs. 14.9% during the placebo phase (p=0.073). There were no significant differences between treatments for secondary outcomes, though a carryover effect on pain pressure threshold was observed for the lidocaine phase (p=0.015). 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (p=0.036).

The differences favoring lidocaine were small and non-significant, but the trend towards superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit.

Steven P. Cohen, Thomas M. Larkin, Aidan S. Weitzner, Edward Dolomisiewicz, Eric J. Wang, Annie Hsu, Mirinda Anderson-White, Marin S. Smith, Zirong Zhao; Multicenter, Randomized, Placebo-controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain. Anesthesiology 2024; 140:513–523 doi: https://doi.org/10.1097/ALN.0000000000004857

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for platform presentation at the 2024 Extremities War Injury Symposium

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

Crowell M, Thomasma E, Miller E, Brindle R, Roach M, Goss D, Pitt W

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Static balance is often impaired in patients after ankle sprains. The ability to identify balance control impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess static balance and shows promise as an accessible method to quantify changes in balance control after injury. The purpose of this study was to determine the validity and responsiveness of the Sway Balance Mobile Application (SWAY) to assess balance control after an acute ankle sprain. We hypothesized the application could differentiate individuals with an ankle sprain from healthy controls, measure improvements in balance control over time, and demonstrate strong correlation with the laboratory assessments of static balance control.

The SWAY mBESS is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated discriminant validity detecting balance differences between a healthy and injured group, convergent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain.

Carreno L, Miller E, Goss D, Mason J, Pitt W, Crowell M

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Ankle sprains are one of the most common injuries sustained in the military, resulting in lost time from duty and persistent disability. Transcranial direct current stimulation (tDCS) is a novel intervention used to rehabilitate athletic injuries and improve sports performance and may contribute to improved outcomes following ankle sprains. The purpose of this study was to evaluate the effectiveness of tDCS in addition to standard rehabilitation compared to standard rehabilitation alone on pain, self-reported function, strength, functional performance, and postural stability following acute inversion ankle sprain.

Future studies may consider investigating tDCS targeted to patients more likely to demonstrate changes in cortical excitability or neuroplasticity in addition to whether the application of tDCS following acute ankle sprain reduces the likelihood of developing chronic ankle instability.Future studies may consider investigating tDCS targeted to patients more likely to demonstrate changes in cortical excitability or neuroplasticity in addition to whether the application of tDCS following acute ankle sprain reduces the likelihood of developing chronic ankle instability.

Goss D, Gaunaurd I, Helton M, Applegate B, Bennett C, Haltiwanger H, Reilly N, Gonnella M, Black J, Deol G, Garr E, Thompson C, Gailey R

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

The Region of Limb Stability (ROLS) quantifies static lower limb (LL) balance and stability by assessing segmental excursion during single limb stance (SLS). Previous research has established that the ROLS metric predicts LL musculoskeletal (MSK) injury occurrence in Division I Collegiate Athletes. Lower Limb injuries are a prevalent reason for Soldiers seeking medical care; therefore, predicting injuries has large implications on readiness. ROLS can be used as screening tool for identifying at-risk SMs who may require additional physical therapy assessment and/or pre-injury/prehab interventions to reduce the risk of MSK injury. The purpose of this study is to characterize ROLS in Active Duty SMs.

Nearly 30% of the SMs tested were at a high risk for LL MSK injury during baseline screening. Those at highest risk included Non-Commissioned Officers (E5-E9 rank). These findings suggest that ROLS can be used as a screening assessment tool to identify individuals at risk for LL MSK injuries and proactively intervene with further assessment and/or the implementation a pre-injury/prehab intervention. Further research is warranted to determine the effectiveness of ROLS SI as a routine tool for the reduction of injuries in Active Duty SMs.

Ignacio Alejandro Gaunaurd I, Helton M, Goss D, Applegate B, Bennett C, Gonnella M, Haltiwanger H, Reilly N, DeMichele S, Linowes S, Hunt A, Troiano M, Besowshek A, Gailey R

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Service Members (SMs) are at risk for musculoskeletal (MSK) injuries, especially injuries that affect the lower limbs (LL) and the ability to perform their duties. Therefore a screening measure designed to determine risk for LL MSK injuries would be meaningful. Recently, wireless sensors have been used to measure joint kinematics with the purpose of assessing performance and by extension quantifying risk of injury. Unique metrics derived from novel algorithms, such as the Transitional Angular Displacement of Segment (TADS), have been validated to assess dynamic balance, lower limb stability, and agility during the four-meter sidestep test (FmSST) in Collegiate Athletes. The purpose of this study is to characterize TADS in Active Duty SMs.

Eight percent of the SMs tested are at a high risk for LL MSK injury based on TADS screening. This is a considerable number of SMs who potentially could be injured resulting in limited duty, increased health costs or not achieving career goals.

Whitehurst r, Romanello a, Davis s, Reilly n, Goss d

Abstract accepted for the 2024 American Physical Therapy Association Combined Sections Meeting

By the nature of their work, Soldiers are regularly subjected to vigorous physical activity and corresponding increases in musculoskeletal injury risk1,2. Holistic Health & Fitness (H2F) is an interdisciplinary approach developed for the implementation of multidimensional care and attainment of optimal performance within the U.S. Army. Specifically, H2F was developed to enhance physical, mental, spiritual, nutritional and sleep readiness for Soldiers in contrast to reactive management of injury-induced symptomology observed in many hospital settings3. This study examined the clinical outcomes and corresponding efficacy of the H2F program in comparison to standards of practice currently in place across the U.S. Military Health System.

The H2F program saw more expedient treatment operations for Soldiers with musculoskeletal injury and observed significantly improved clinical outcomes compared to standard practices conducted at major hospitals.

Mabry L, Ross M, Reilly N, Young B, Keil A, Gisselman A, Davenport T, Goss D

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

The purpose of this study was to examine physical therapist awareness and utilization of diagnostic imaging referral privileges. A secondary purpose was to determine if self-reported direct access frequency impacted diagnostic imaging referral or utilization of diagnostic imaging skills.

 There is a general lack of awareness of imaging privileges among physical therapists which appears to be influenced by level of jurisdictional scope. Awareness of imaging privileges significantly impacts its likelihood of incorporation into practice. The American Physical Therapy Association (APTA) should consider working with state boards to raise imaging privilege awareness potentially via integration into a jurisprudence exam. Additionally, this study further links diagnostic imaging referral as an essential tool for direct access. This further supports expansion of physical therapist diagnostic imaging referral to all 50 states consistent with direct access authority.

Galvin J, egan a, Rooney P, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for the 2024 American Academy of Orthopaedic Surgeons Annual Meeting

Little is known about the pathobiology of unidirectional anterior and posterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and capsular tissue of young patients with recurrent anterior shoulder instability and those patients with unidirectional posterior shoulder instability.

There are significant gene expression differences in the shoulder capsule of anterior and posterior shoulder instability patients. This transcriptomic data may provide an improved understanding of the pathobiology of various forms of shoulder instability which could lead to future precision medicine approaches.

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for the 2024 American Academy of Orthopaedic Surgeons Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

Smith m, Abboud Chalhoub c, Hogaboom n, Dellanno r, St Laurent m, Yuan x, Nordstrom m

Abstract accepted for a platform presentation at the 2024 American Physical Therapy Association Combined Sections Meeting

Chronic neck pain is a common health condition for military personnel across all occupational specialties. A recent (2023) systematic review highlighted the need for higher level evidence regarding the efficacy of conservative interventions for musculoskeletal pain conditions in this population. The etiology of neck pain is often multi-factorial and can include mechanical (e.g., poor posture), occupational (e.g., desk work, manual labor), and psychosocial factors (e.g., anxiety, depression). The reduction of cervical lordosis in forward head posture (FHP) can lead to muscular imbalances, degenerative spinal changes, and heightened neck pain. The efficacy of a FHP therapy collar is being explored within the military population with chronic neck pain in an ongoing randomized waitlist-controlled trial at a military medical center.

Evaluating the treatment effect of a simple, non-invasive, wearable device for neck pain is highly relevant to the military considering the unique occupational and fitness requirements. Recent studies have suggested that current treatment strategies may be less effective within this population. This participant demonstrated improved posture, neck pain reduction and improved function after wearing the FHP therapy collar for 6 weeks in comparison to 6 weeks of no collar use. This ongoing trial will shed further light on the potential utility of this novel device in reducing neck pain due to FHP, and thereby improve functional outcomes and operational readiness.

Negri LB, Fairnelli WA, Korupolu S, Tam J, Gelfand J

Abstract accepted for a poster session at the 2023 Military Health System Research Symposium

Bacterial biofilm infections play a critical role in wound pathogenesis, enabling bacteria to defend themselves against both antibiotics and host defenses. They enhance persistence of infection, permitting spread of infection, delay of healing, and the development of antimicrobial resistance, all potentially contributing to sepsis and death from wounds. Antibiotic drugs are 10- to- 1,000-fold less effective against bacterial biofilm cultures than standard mean inhibitory concentration (MIC) reports indicate. We are developing ways to bring antimicrobial blue light (aBL) into patient care, specifically for treating wounds, with a special focus on the potential for this mode of therapy to overcome antimicrobial resistance (AMR) in biofilms. Antimicrobial blue light (herein 405nm) involves photochemical reactions with endogenous chromophores in bacteria that result in the release of reactive oxygen species (ROS), which are highly cytotoxic for bacteria. However, aBL penetrates tissue poorly, so this modality is best suited to the treatment of visible, light- accessible wounds. In this setting, aBL is a topical treatment to substantially reduce the bacterial bioburden, preventing more serious, penetrating infection. Thus, topically acting agents enhancing aBL would be useful. We have previously demonstrated that vitamin K 3/menadione could enhance aBL antimicrobial activity. A photosensitizer is a molecule that absorbs light and undergoes a photochemical reaction in which it typically donates an electron to a target substrate, generating reactive molecular species which, in turn, may have a biological effect. In this report, we have demonstrated that menadione acts as a therapeutic photosensitizer to kill bacteria upon illumination with aBL, elucidating some of the mechanisms, and additionally demonstrating this adjuvant effect in a porcine skin explant, ex vivo wound- biofilm model.

Penafiel A, Metzger E, Hager N, Wagner L, Isaacson B, Pasquina P, Werner K

Abstract accepted for a poster session at the 2023 USU Research Days

The average sleep quality in the military is so poor that the cutoff in validated subjective sleep quality complaint measures is twice as high as that in civilians. More than two-thirds of the military report sleeping less than the recommended seven hours per night. This sleep restriction (SR) can lead to reduced reaction time, verbal fluency, working and visual memory, and information processing, all of which are key functions in the completion of military activities. SR can also lead to atrophy of hippocampal subregions and other long term neurobehavioral consequences. The current mechanisms to combat SR, including caffeine, psychostimulants, and exercise, have varying effectiveness and short-lived results; therefore, an intervention with long-lasting effects is needed. 

Photobiomodulation therapy (PBMT) is a non-invasive intervention that applies non-ionizing light to the body to enhance performance, stimulate healing, moderate recovery, and improve health. Red/infrared PBMT (e.g. 600-900 nm) is known to be absorbed by cytochrome c oxidase within the mitochondria, facilitating electron transfer efficiency and doubling adenosine triphosphate production in cells. PBMT delivered via intranasal applicators, diode lasers, and/or light treatment helmet devices has been shown to penetrate the skin and skull, resulting in modulated brain activity. One study utilized electroencephalography (EEG) to measure the effects of transcranial PBMT (tPBMT) on neural oscillations. tPBMT modulated oscillatory frequencies for delta, theta, alpha, beta, and gamma bands, as well as affected the power and functional connectivity of internal brain activity. Additionally, tPBMT using near infrared light has been shown to potentially improve cognitive function, attention, and executive function, supporting its use in neurological interventions. 

Two placebo-controlled studies have examined the effect of PBMT on sleep in athletes after dosing the whole body with multiple short exposures. One study using noncoherent red light with a wavelength of 685nm dosed at 30 J/cm2 was associated with improved subjective sleep quality, increased total sleep time, and decreased sleep onset latency. They also demonstrated the PBMT group had a significant increase in morning serum melatonin. Conversely, a separate study found that PBMT dosed at 14.4 J/cm2 with an irradiance of 0.012W/cm2 decreased total sleep time but increased the percentage of N2 and N3 sleep, while improving sleep quality. The mechanisms of efficacy remain unclear. While neither study examined objective measures of brain activity during wake or sleep, we hypothesize that brain exposure to PBMT will optimize energetics for the coordinated firing involved in the deepest "slow-wave" sleep, yielding increased power in the delta band and improved sleep quality. This abstract provides the methods and expected outcomes of our study that will explore the application of PBMT in a military sample to characterize the effects of this modality on sleep. 

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for platform presentation at the 2023 Society of Military Orthopaedic Surgeons (SOMOS) Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

Smith M, Yuan X, Smith J, deal b, Nanos G, Tintle S, Reece D, Miller M

Abstract accepted for presentation at the 2023 SOMOS Annual Meeting

Carpal Tunnel Syndrome (CTS) is the most common peripheral entrapment neuropathy, impacting the health of the general population, as well as the performance and readiness of active duty service members (ADSMs) and military beneficiaries.1-2 CTS occurs when the median nerve (MN) is compressed beneath the transverse carpal ligament (TCL) within the carpal tunnel (CT). Within the general workforce, the incidence of CTS is between 1.5 and 3.5 per 1,000 person-years.3 According to Wolf et al., the raw incidence of CTS in the United States (U.S.) military is 3.98 per 1,000 person-years.4 CTS risk factors include female gender, increasing age, poor wrist posture, and occupations that involve repetitive movements, forceful grip, and exposure to vibration.3-5 Occupational risk factors are particularly relevant in the setting of the Military Health System (MHS), as different military occupational specialties may predispose ADSMs to CTS. Notably, CTS can impact operational readiness, prompting the need to improve diagnostic and treatment options for this common health condition, focusing on safety and efficiency to facilitate quicker return to duty. To this end, high-frequency ultrasound (HFUS) has demonstrated utility in CTS diagnosis and may serve as a valuable tool to improve overall safety during CTS treatment.

CTS diagnosis and treatment are typically guided by patient complaints, physical examination, and electrodiagnostic studies (EDX). The 2012 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)’s evidence-based guideline on the use of neuromuscular ultrasound (US) in the diagnosis of CTS concluded that US adds diagnostic value to EDX, focusing specifically on measuring the MN cross-sectional area (CSA) at the wrist as a diagnostic tool.6 Additionally, the guideline recommended that US be considered in screening for anatomic abnormalities. However, the 2016 American Academy of Orthopedic Surgeons’ clinical practice guidelines indicate limited evidence in support of routine US pre-operative exams, specifying a need for higher-level evidence regarding the utility of US, with a focus on establishing optimal measurement and cut-off values, in alignment with AANEM's guidelines for future research.7 More recently, studies have demonstrated that utilizing a cut-off CSA of 10-12 mm2 can differentiate between patients with normal versus abnormal EDX.8-9 However, Chen et al. demonstrated that US measurements were unable to differentiate levels of severity, indicating EDX remains a useful tool for grading CTS severity.9

CTR by endoscopic (ECTR) or mini-open (mOCTR) approach is the current standard of care (SOC) in the MHS for management of refractory CTS. CTR techniques have continued to evolve to further reduce post-operative symptoms and iatrogenic injury risk, while promoting quicker recovery and better functional outcomes. CTR using Ultrasound Guidance (CTR-US) is a promising treatment option for military beneficiaries with CTS, currently under rigorous study in a single-site pragmatic randomized controlled feasibility trial at a military medical center. Both ECTR and CTR-US involve smaller incisions and alternative means of visualization (i.e., endoscope or US). Although rare, intra-operative complications can occur during CTR secondary to anatomic variations. Multiple surgeons have emphasized the need for increased awareness of anatomic variations of the muscles, nerves, and vasculature within the CT region to promote procedural safety.15-17 Neurovascular injury can result in increased post-operative pain, persistent paresthesias, and/or excessive bleeding, all of which may contribute to an extended, complicated post-operative course, impacting return to work/duty and overall quality of life.

Key variations in neurovascular anatomy include a high bifurcation of the median nerve (approximately 6%), transligamentous thenar motor branch of the MN (TMB; <10%), multiple TMBs (<1% in patients with normal versus hypertrophic thenar musculature), ulnar course of the palmar cutaneous branch of the MN (PCBMN; <3%), persistent median artery (PMA; 1.2 – 23%), and superficial ulnar artery (UA; <10%).15-19 Prior studies have demonstrated that HFUS can be utilized to reliably identify these key variations that are at risk during CTR.10-14 Therefore, pre-operative US exams can identify anatomic variations and aid decision-making of the most appropriate CTR approach. This case series presents three participants in the feasibility trial of CTR-US who received pre-operative diagnostic US examinations, which detected distinct anatomic variants that were integral to subsequent treatment planning for CTR.

Galvin J, Rooney P, Tokish J, Grassbaugh J, Masini B, Free K, Bastian M, Gillette L, Colburn Z

Abstract accepted for platform presentation at the 2023 Washington State Orthopaedic Association (WSOA) Annual Meeting

Currently the measurement of serum or synovial biomarkers does not have a role in diagnosis or monitoring of injury severity in young patients with recurrent anterior shoulder instability. The purpose of this study was to compare gene expression differences in the peripheral blood and tissue of young patients with recurrent anterior shoulder instability with and without significant glenoid bone loss (GBL). Additionally, we sought to determine a peripheral blood transcriptomic biomarker for the reliable delineation of the severity of GBL in anterior shoulder instability patients.

There are significant gene expression differences in the peripheral blood of anterior shoulder instability patients with and without significant (≥10%) GBL. The differential expression of 5 genes allowed development of an accurate predictive model and transcriptomic classifier to predict the severity of GBL. This novel peripheral blood transcriptomic biomarker may assist in tracking glenoid bone loss and injury severity and progression in young patients with recurrent anterior shoulder instability.

Bullock GS, Dartt Ce, Ricker EA, arden N, clifton D, danelson K, fraser jj, gomez c, greenlee ta, gregory a, gribbin t, losciale j, molloy jm, nicholson kF, polich jg, raisanen a, shah k, smuda m, teyhen ds, allard rj, collins gs, de la motte sj, rhon di

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. This review concluded that 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.

Bullock GS, Dartt CE, Ricker EA, et al Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review. Injury Prevention Published Online First: 23 August 2023. doi: 10.1136/ip-2023-044905

Ong J, Nazarian A, Tam J, farinelli W, Korupolu s, Drake L, Isaacson B, Pasquina P, Williams D

Antimicrobial blue light (aBL) is an attractive option for managing biofilm burden at the skin-implant interface of percutaneous osseointegrated (OI) implants. However, marketed aBL devices have both structural and optical limitations that prevent them from being used in an OI implant environment. They must be handheld, preventing even irradiation of the entire skin-implant interface, and the devices do not offer sufficient optical power outputs required to kill biofilms. We present the developmental process of a unique aBL device that overcomes these limitations. Four prototypes are detailed, each being a progressive improvement from the previous iteration as we move from proof-of-concept to in vivo application. Design features focused on a cooling system, LED orientation, modularity, and “sheep-proofing”. The final prototype was tested in an in vivo OI implant sheep model, demonstrating that it was structurally and optically adequate to address biofilm burdens at the skin-implant of percutaneous OI implants. The device made it possible to test aBL in the unique OI implant environment and compare its efficacy to clinical antibiotics–data which had not before been achievable. It has provided insight into whether or not continued pursual of light therapy research for OI implants, and other percutaneous devices, is worthwhile. However, the device has drawbacks concerning the cooling system, complexity, and size if it is to be translated to human clinical trials. Overall, we successfully developed a device to test aBL therapy for patients with OI implants and helped progress understanding in the field of infection management strategies.

Ong J, Nazarian A, Tam J, Farinelli W, Korupolu S, Drake L, et al. (2023) An antimicrobial blue light device to manage infection at the skin-implant interface of percutaneous osseointegrated implants. PLoS ONE 18(8): e0290347. https://doi.org/10.1371/journal.pone.0290347