Schoenfeld Andrew J, Goodman Gens P, Burks Robert, Black Michael A, Nelson James H, Belmont Philip J
Department of Orthopaedic Surgery, University of Michigan, 2800 Plymouth Road, Building 10, RM G016, Ann Arbor, MI 48109. E-mail address:
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 North Piedras Street, El Paso, TX 79920.
J Bone Joint Surg Am. 2014 Jul 2;96(13):e106. doi: 10.2106/JBJS.M.01050.
The extent to which musculoskeletal injuries and sociodemographic factors impact long-term outcome remains unknown. The purpose of this study was to provide a prognostic analysis of the influence of musculoskeletal conditions, behavioral health diagnoses, and patient-based characteristics on outcomes among a longitudinal cohort.
This is a longitudinal observational study of the population of an Army brigade deployed to Iraq from 2006 to 2007. The 4087 soldiers who survived the deployment were followed for forty-eight months and were observed for the development of chronic musculoskeletal conditions, behavioral health disorders, and inability to remain in active service as indicated by the findings of the Physical Evaluation Board. The influence of demographic factors, behavioral health conditions, and deployment-related musculoskeletal injuries on the capacity to remain in the military was assessed using Poisson multivariate analysis and receiver operating characteristic curves.
The mean age of the cohort was twenty-seven years (range, eighteen to fifty-two years). One hundred and sixty-three soldiers sustained combat-related musculoskeletal trauma, and 587 soldiers had musculoskeletal injuries not related to battle. Three hundred and seventy-four soldiers (9%) were found to be unfit by the Physical Evaluation Board, with 236 soldiers (63%) referred for at least one musculoskeletal condition. Of these 236 soldiers, 116 (49%) also had a behavioral health diagnosis. Multivariate regression analysis revealed that junior enlisted rank (incidence rate ratio, 9.7 [95% confidence interval, 3.1 to 30.3]), senior enlisted rank (incidence rate ratio, 5.6 [95% confidence interval, 1.8 to 17.7]), behavioral health diagnosis (incidence rate ratio, 7.4 [95% confidence interval, 5.6 to 9.6]), age of eighteen to twenty-three years (incidence rate ratio, 1.6 [95% confidence interval, 1.2 to 2.3]), and male sex (incidence rate ratio, 2.5 [95% confidence interval, 1.2 to 5.0]) were significant predictors of referral to the Physical Evaluation Board for a musculoskeletal condition. A prognostic model developed using receiver operating characteristic curves and the risk factors of musculoskeletal injury, presence of a psychiatric condition, and lower rank explained 78% (95% confidence interval, 77% to 80%) of the risk of being found unfit by the Physical Evaluation Board.
Musculoskeletal conditions, psychological diagnoses, and lower rank (socioeconomic status) were identified as potent predictors of inferior outcome in this study. Targeting at-risk patients within populations may improve results.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
肌肉骨骼损伤和社会人口统计学因素对长期预后的影响程度尚不清楚。本研究的目的是对肌肉骨骼疾病、行为健康诊断以及基于患者的特征对纵向队列研究结果的影响进行预后分析。
这是一项对2006年至2007年部署到伊拉克的一个陆军旅的人群进行的纵向观察性研究。对4087名在部署中幸存下来的士兵进行了48个月的随访，观察慢性肌肉骨骼疾病、行为健康障碍的发生情况，以及体能评估委员会的评估结果所显示的无法继续服现役的情况。使用泊松多变量分析和受试者工作特征曲线评估人口统计学因素、行为健康状况和与部署相关的肌肉骨骼损伤对继续服役能力的影响。
该队列的平均年龄为27岁（范围为18至52岁）。163名士兵遭受了与战斗相关的肌肉骨骼创伤，587名士兵有与战斗无关的肌肉骨骼损伤。体能评估委员会发现374名士兵（9%）不适合服役，其中236名士兵（63%）因至少一种肌肉骨骼疾病被转诊。在这236名士兵中，116名（49%）也有行为健康诊断。多变量回归分析显示，初级士兵军衔（发病率比值，9.7 [95%置信区间，3.1至30.3]）、高级士兵军衔（发病率比值，5.6 [95%置信区间，1.8至17.7]）、行为健康诊断（发病率比值，7.4 [95%置信区间，5.6至9.6]）、18至23岁年龄（发病率比值，1.6 [95%置信区间，1.2至2.3]）和男性（发病率比值，2.5 [95%置信区间，1.2至5.0]）是因肌肉骨骼疾病被转诊到体能评估委员会的显著预测因素。使用受试者工作特征曲线和肌肉骨骼损伤、精神疾病的存在以及较低军衔等危险因素建立的预后模型解释了体能评估委员会认定不适合服役风险的78%（95%置信区间，77%至80%）。
在本研究中，肌肉骨骼疾病、心理诊断和较低军衔（社会经济地位）被确定为不良预后的有力预测因素。针对人群中的高危患者可能会改善结果。
预后IV级。有关证据水平的完整描述，请参阅作者须知。
