ABSTRACT
PURPOSE: Research suggests the importance of psychosocial factors in recovery from musculoskeletal injuries. The objective of this study was to identify predictors of recovery among U.S. Marines who had musculoskeletal injuries of the back, knee, or shoulder. METHODS: A sample of 134 participants was assessed at baseline and followed for 1 year to determine outcome information. RESULTS: The strongest predictor of injury recovery at the 1-year follow-up was recovery expectations. In a multivariate logistic model with key demographic and psychosocial factors controlled, individuals who had high recovery expectations at baseline were over five times as likely to be recovered at follow-up as individuals who had low expectations (OR = 5.18, p\.01). CONCLUSIONS: This finding is consistent with a large body of research that has linked recovery expectations with better recovery outcomes in patients with musculoskeletal injuries as well as with research linking recovery expectations with better outcomes across a wide range of medical conditions.Applied to military populations, interventions designed to modify recovery expectations may have the potential to improve rates of return to duty and to reduce rates of disability discharge.
Subject(s)
Attitude to Health , Back Injuries/rehabilitation , Knee Injuries/rehabilitation , Military Personnel/psychology , Return to Work/psychology , Adolescent , Adult , Back Injuries/psychology , Catastrophization/psychology , Depression/psychology , Fear/psychology , Female , Follow-Up Studies , Humans , Job Satisfaction , Knee Injuries/psychology , Male , Naval Medicine , Pain Measurement , Prospective Studies , Recovery of Function , Shoulder Injuries , Social Support , United States , Young AdultABSTRACT
A transition from traditional problem-based clinics to the Sports Medicine and Reconditioning Team (SMART) clinic model was completed by January 2009 at Marine Corps Base Camp Lejeune. The SMART clinic model allows for more patients to be seen and enhances coordinated care between providers. The objective of this research is to show the advantages of implementing a training room team approach for the care of musculoskeletal injuries in active duty members by comparing the number of patients seen, the number of limited duty (LIMDU) periods, the number of physical evaluation boards (PEBs), and the percentage of orthopedic referrals. Electronic medical records for patients seen at sports medicine clinics between January 1, 2007 and December 31, 2010 were reviewed. Naval Hospital Camp Lejeune provided a database of patients placed on LIMDU and PEB from 2007 through 2010. Fifty-eight and twenty-four percent more encounters occurred in 2009 and 2010, respectively, than that in 2007. The percentage of LIMDU referred for PEB in 2010 was reduced to 9% compared to that in 2007. In conclusion, the SMART clinic model allows for more patients to be seen and a reduction in the percentage of patients recommended for PEB from LIMDU.
Subject(s)
Hospitals, Military/statistics & numerical data , Military Medicine/methods , Musculoskeletal System , Sports Medicine/methods , Wounds and Injuries/rehabilitation , Databases, Factual , Electronic Health Records , Health Care Reform , Health Services Accessibility , Humans , Military Medicine/organization & administration , North CarolinaABSTRACT
Exertional heat injuries have gained public attention over the past several years, as have the means to prevent and treat them. One of the simplest preventive measures is to refrain from physical training and competition during times of increased environmental heat stress. Unfortunately, this often is not possible or desirable in certain populations. As a result of operational and training requirements, the U.S. Marine Corps and the U.S. Navy medical team have developed an effective exertional heat injury prevention strategy that relies upon education, leadership, and continuous hands-on observation. The fundamental aspects of this approach can be applied to other team sporting activities.
Subject(s)
Heat Stress Disorders/prevention & control , Inservice Training , Military Personnel , Heat Stress Disorders/diagnosis , Heat Stress Disorders/therapy , Humans , Physical Fitness , Risk Factors , United StatesABSTRACT
Since Biblical times, heat injuries have been a major focus of military medical personnel. Heat illness accounts for considerable morbidity during recruit training and remains a common cause of preventable nontraumatic exertional death in the United States military. This brief report describes current regulations used by Army, Air Force, and Navy medical personnel to return active duty warfighters who are affected by a heat illness back to full duty. In addition, a description of the profile system used in evaluating the different body systems, and how it relates to military return to duty, are detailed. Current guidelines require clinical resolution, as well as a profile that that protects a soldier through repeated heat cycles, prior to returning to full duty. The Israeli Defense Force, in contrast, incorporates a heat tolerance test to return to duty those soldiers afflicted by heat stroke, which is briefly described. Future directions for U.S. military medicine are discussed.
