Rhon Daniel I, de la Motte Sarah J, Fraser John J, Greenlee Tina A, Hando Benjamin R, Molloy Joseph M, Teyhen Deydre S, Tiede Jeffrey M, Van Wyngaarden Joshua J, Westrick Richard B, Bullock Garrett S
Department of Rehabilitation Medicine, Brooke Army Medical Center, TX, USA; Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University, MD, USA.
Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.
Injury. 2025 Feb;56(2):112029. doi: 10.1016/j.injury.2024.112029. Epub 2024 Nov 20.
Musculoskeletal injuries enact a substantial burden in military settings, incurring high costs, long-term disability, and impacting military readiness. This has led to a prioritization of injury prevention programs. Understanding the challenges faced by those trying to implement these programs could help standardize and better inform future efforts. The purpose was to capture perceptions of barriers and facilitators to implementation of injury prevention programs in the US Armed Forces.
A cross-sectional survey with open-ended questions was circulated to relevant stakeholders; key themes were derived using conceptual content analysis. Four questions were asked concerning injury prevention programs: 1) barriers, 2) facilitators, 3) how can leadership best support, and 4) how can subject matter experts best collaborate to make these programs successful?
The survey reached at least 300 individuals working with the armed services worldwide; 91 completed the survey. The mean (SD) time working with military service members was 11.5 (8.2) years; 93 % worked with active-duty service members, 71.4 % were licensed healthcare providers, and 55 % worked in settings with established injury prevention programs. Only 45.2 % of participants believed an appropriate, clear way to measure program success currently exists. Nearly 85 % believed that lacking standardization of definitions and metrics hinders program assessment. Wide variability existed in opinions regarding who should be primarily responsible for promoting/supporting injury prevention efforts. Key themes included resources as both a facilitator (when present) and barrier (when absent), organizational culture, and leadership support. Leadership can best help by prioritizing the programs and valuing the programming through modeling the desired behavior. Program staff can collaborate by focusing on enabling change, integrating into organizational/unit culture and collaborating with leaders to change policy.
Factors leading to incidence and recovery of musculoskeletal injuries are multifactorial, requiring collaborative multidisciplinary approaches for optimal injury prevention program development and implementation. Leadership support/prioritization, unit-level cultural acceptance and sufficient resources are essential facilitators to implementing prevention programs. Developing standardized, relevant metrics for assessing program effectiveness and establishing organizational best practices are necessary for long term program viability and lasting change.
肌肉骨骼损伤在军事环境中造成了沉重负担，带来了高昂成本、长期残疾，并影响军事准备状态。这导致了对 injury prevention programs 的优先重视。了解那些试图实施这些项目的人所面临的挑战，有助于规范并更好地指导未来的工作。目的是了解美国武装部队中 injury prevention programs 实施的障碍和促进因素。
向相关利益相关者发放了一份包含开放式问题的横断面调查问卷；使用概念性内容分析得出关键主题。就 injury prevention programs 提出了四个问题：1）障碍，2）促进因素，3）领导层如何提供最佳支持，4）主题专家如何最佳协作以使这些项目取得成功？
该调查至少覆盖了全球 300 名与武装部队合作的人员；91 人完成了调查。与军事人员合作的平均（标准差）时间为 11.5（8.2）年；93%与现役军人合作，71.4%是有执照的医疗保健提供者，55%在设有 injury prevention programs 的环境中工作。只有 45.2%的参与者认为目前存在衡量项目成功的适当、明确方法。近 85%的人认为缺乏定义和指标的标准化阻碍了项目评估。在谁应主要负责促进/支持 injury prevention efforts 的问题上，意见存在很大差异。关键主题包括资源既是促进因素（存在时）又是障碍（缺乏时）、组织文化和领导层支持。领导层通过优先考虑这些项目并通过树立期望行为来重视这些项目，能提供最佳帮助。项目工作人员可以通过专注于促成变革、融入组织/单位文化并与领导层合作以改变政策来进行协作。
导致肌肉骨骼损伤发生和恢复的因素是多方面的，需要协作性多学科方法来优化 injury prevention programs 的开发和实施。领导层支持/优先考虑、单位层面的文化接受和充足资源是实施预防项目的重要促进因素。制定标准化、相关的指标来评估项目有效性并建立组织最佳实践对于项目的长期可行性和持久变革是必要的。
