Foulis Stephen A, Proctor Susan P, Spiering Barry A, Walker Leila A, Guerriere Aaron Katelyn, Castellani Colleen M, Hussian Ian M, Heaton Kristin J, Bouxsein Mary L, Gaffney-Stomberg Erin, Fraley Amy L, Popp Kristin L, Davis Irene S, Staab Jeffery S, Staab Janet E, Judkins Jason L, Merkle Shannon L, Ritland Bradley M, Matheny Ronald W, Hauret Keith G, Canham-Chervak Michelle, McClung James P, Jones Bruce H, Friedl Karl E, Hughes Julie M, Taylor Kathryn M
Military Performance Division, Army Research Institute of Environmental Medicine, Natick, Massachusetts.
Research Service, Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.
JAMA Netw Open. 2025 Jun 2;8(6):e2513177. doi: 10.1001/jamanetworkopen.2025.13177.
Musculoskeletal injuries (MSKIs) are pervasive problems in novice training environments. Evaluation of modifiable and nonmodifiable risk factors of MSKI risk prior to entry into these environments is largely understudied.
To provide military leaders, civilian and military clinicians, and physical training instructors with an MSKI risk model for identifying low-, moderate-, and high-risk profiles among individuals starting US Army Basic Combat Training (BCT) or a physical training program.
DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, data collection was conducted between August 5, 2017, and April 15, 2023, at 2 US Army BCT sites. The sample consisted of volunteer trainees between the ages of 17 and 41 years. They were followed up from the start of BCT. Data analyses were conducted from April to September 2024.
Data for the factors potentially associated with MSKI were collected during the first week of BCT and included blood draws, total body dual-energy x-ray absorptiometry, and muscle power test results; surveys of demographics, medical history, physical activity, psychological characteristics, and sleep patterns; and physical fitness results.
MSKIs identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Logistic regression-based models estimating the risk of MSKI were generated using 5-fold internal cross-validation for the total cohort, males, and females. Traffic light model examples of low (green), moderate (amber), and high (red) MSKI risk tiers were produced.
In this cohort study of 2988 Army trainees (median [IQR] age, 19.0 [19.0-22.0] years; 1880 males [62.9%]), 729 females (49.0%) and 758 males (51.0%) had an ICD-10 code-identified MSKI, and 1067 (35.7%) had more than 1 ICD-10 code-identified MSKI. Factors associated with increased MSKI risk in the total cohort and female- and male-specific MSKI risk models (with areas under the receiver operator characteristic curve of 0.701, 0.678, and 0.661, respectively) encompassed 7 variable categories: demographics; anthropometrics and body composition; nutritional status; medical and health history; history of sports and past or current physical activity or fitness; psychological factors (ie, pain, grit, and hardiness); and sleep parameters.
This cohort study presents a tiered approach to identifying persons at increased MSKI risk before the start of a physical training program. Applying a tiered quantification risk metric and incorporating multifactorial interventions from these findings may play a role in reduced MSKI risk.
肌肉骨骼损伤（MSKIs）是新手训练环境中普遍存在的问题。在进入这些环境之前，对MSKI风险的可改变和不可改变风险因素的评估在很大程度上尚未得到充分研究。
为军事领导人、文职和军事临床医生以及体能训练教官提供一个MSKI风险模型，用于识别开始美国陆军基础战斗训练（BCT）或体能训练计划的个人中的低、中、高风险特征。
设计、设置和参与者：在这项前瞻性队列研究中，于2017年8月5日至2023年4月15日在美国陆军的2个BCT站点进行数据收集。样本包括年龄在17至41岁之间的志愿受训人员。从BCT开始对他们进行随访。数据分析于2024年4月至9月进行。
在BCT的第一周收集与MSKI潜在相关因素的数据，包括血液检测、全身双能X线吸收测定法和肌肉力量测试结果；人口统计学、病史、身体活动、心理特征和睡眠模式的调查；以及体能测试结果。
使用《疾病和相关健康问题国际统计分类》第十次修订版（ICD - 10）编码识别MSKIs。使用5折内部交叉验证为整个队列、男性和女性生成基于逻辑回归的估计MSKI风险的模型。给出了低（绿色）、中（琥珀色）和高（红色）MSKI风险等级的交通信号灯模型示例。
在这项对2988名陆军受训人员的队列研究中（年龄中位数[四分位间距]为19.0[19.0 - 22.0]岁；1880名男性[62.9%]），729名女性（49.0%）和758名男性（51.0%）有ICD - 10编码识别的MSKI，1067名（35.7%）有不止1个ICD - 10编码识别的MSKI。在整个队列以及女性和男性特定的MSKI风险模型中（受试者工作特征曲线下面积分别为0.
