Table 2

Identified research gaps for implementation of military injury mitigation and prevention programmes

Research gapsExplanation
Effectiveness of injury mitigation and prevention programmes for female compared with male military service membersThree percent of primary articles investigated MSK-IMPPs exclusively in military women, while 69% included only men. In studies with mixed populations, assessing outcomes by sex (eg, sex-specific modelling with appropriately powered studies) can elucidate factors relevant to each sex. Also, including qualitative methods, such as focus groups, may help stakeholders understand the unique needs of women regarding injury mitigation and prevention programmes, and how they might differ from those tailored to men.
Investigating and reporting MSK-IMPP implementation frameworks and strategiesImplementation frameworks can be used to evaluate the context of MSK-IMPPs during its design and formulate strategies for implementation. However, this review found that implementation context and strategies were rarely evaluated formally and/or reported in studies. The curated information about MSK-IMPP implementation was extracted from discussion sections and author comments in reviews, rather than formal evaluation and reporting of implementation context, strategies or outcomes. This further underscores the existing gap of poor implementation reporting in the military MSK-IMPP.
Investigating and reporting MSK-IMPP implementation outcomesSystematic evaluation of MSK-IMPP includes evaluating and reporting specific implementation outcomes, such as fidelity and maintenance. Evaluating implementation outcomes allows one to identify whether the implementation of the MSK-IMPP was successful separately from evaluating the effectiveness (ie, reduction in MSK-I) of the MSK-IMPP. Few studies included in this review specifically reported implementation outcomes, highlighting a gap in the MSK-IMPP literature.
Lack of consensus and variability in MSK-I definitionsStudies demonstrated wide heterogeneity in definitions of MSK-I, which influences how these programmes are assessed for effectiveness. MSK-I definitions in this review alone included: (1) conditions that required seeking medical care; (2) conditions that prevented subjects from completing their military duties; (3) specific ICD-9 diagnosis codes from medical records; (4) self-reported MSK-I and (5) other information (eg, training data, limited duty time or discharge rates) used either as a surrogate for or in addition to specific injury surveillance data. Further research is needed to reach consensus on standard definitions and common data elements that should be reported in all studies.
MSK-IMPP transportability to other countries and culturesFew studies investigated MSK-IMPP programmes outside of Western Europe and North America. Further research is needed to understand the effectiveness and unique needs for MSK-IMPPs in other countries. However, these findings may be affected by only including studies written in English.
MSK-IMPP scalabilityFew studies investigated expanding MSK-IMPPs to broader populations (ie, across multiple military branches, bases or countries). Programme coordination between multiple entities is needed to assess potential programme scalability.
  • MSK-I, musculoskeletal injury; MSK-IMPP, musculoskeletal injury mitigation and prevention programme.