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

Garrett S Bullock; Carolyn E Dartt; Emily A Ricker; Joanne L Fallowfield; Nigel Arden; Daniel Clifton; Kerry Danelson; John J Fraser; Christina Gomez; Tina A Greenlee; Alexandria Gregory; Timothy Gribbin; Justin Losciale; Joseph M Molloy; Kristen F Nicholson; Julia-Grace Polich; Anu Räisänen; Karishma Shah; Michael Smuda; Deydre S Teyhen; Rhonda J Allard; Gary S Collins; Sarah J de la Motte; Daniel I Rhon

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

Inj Prev. 2023 Nov 27;29(6):461-473. doi: 10.1136/ip-2023-044905.

Authors

Garrett S Bullock^{1

2}, Carolyn E Dartt^{3

4}, Emily A Ricker^{3

4}, Joanne L Fallowfield⁵, Nigel Arden^{6

7}, Daniel Clifton^{3

4}, Kerry Danelson¹, John J Fraser⁸, Christina Gomez⁹, Tina A Greenlee¹⁰, Alexandria Gregory^{3

4}, Timothy Gribbin^{3

4}, Justin Losciale^{11

12}, Joseph M Molloy¹³, Kristen F Nicholson¹, Julia-Grace Polich¹, Anu Räisänen^{14

15}, Karishma Shah⁶, Michael Smuda^{3

4}, Deydre S Teyhen¹⁶, Rhonda J Allard¹⁷, Gary S Collins¹⁸, Sarah J de la Motte^#¹⁹, Daniel I Rhon^#^{20

21}

Affiliations

¹ Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
² Centre for Sport, Exercise, and Osteoarthritis, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK.
³ Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA.
⁴ Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.
⁵ Environmental Medicine and Sciences Division, Institute of Naval Medicine, Gosport, UK.
⁶ Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK.
⁷ University of Southampton MRC Lifecourse Epidemiology Centre, Southampton, UK.
⁸ Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, California, USA.
⁹ College of Health Sciences, Western University of Health Sciences, Pomona, California, USA.
¹⁰ Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA.
¹¹ Department of Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada.
¹² Arthritis Research Canada, Richmond, British Columbia, Canada.
¹³ Office of the Army Surgeon General, Falls Church, Virginia, USA.
¹⁴ Department of Physical Therapy Education, Oregon, College of Health Sciences, Western University of Health Sciences, Lebanon, Oregon, USA.
¹⁵ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Army Medical Specialist Corps Chief, Office of the Army Surgeon General, Falls Church, Virginia, USA.
¹⁷ Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁸ Centre for Statistics in Medicine, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK.
¹⁹ Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA.
²⁰ Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA daniel.rhon@usuhs.edu.
²¹ Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA.

^# Contributed equally.

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.

Publication types

Review

MeSH terms

Female
Humans
Male
Military Personnel*
Musculoskeletal Diseases* / prevention & control
Program Evaluation