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Introduction Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs. Materials and Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for UE MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities (MTF), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (Fiscal Years [FYs] 16–21). Utilization associated with UE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to UE MSKIs were captured for each year. Results In FY21, UE MSKIs occurred in 15.0% of ADSMs (n  = 224,842). From FY16–21, the Army had the highest annual prevalence of UE MSKIs (16.7–18.8%), followed by the Air Force (15.2–17.6%), Marine Corps (13.2–14.7%), and Navy (11.1–12.6%). Incidence rate patterns were similar, with the Army sustaining UE MSKIs at 172 to 199 injuries per 1,000 person-years, followed by the Air Force (150–181), Marines (140–157), and Navy (113–130). Overuse/non-specific MSKIs of the shoulder were the most common UE injury type and body region affected, respectively. There were 5,641,191 DC and 1,290,153 PC outpatient encounters from FY16–21 with a primary or secondary diagnosis of UE MSKI. The Air Force was most reliant on PC, with 31.5% of their UE MSKI-related encounters occurring outside MTFs during FY16–21. Conclusions Among U.S. ADSMs, UE MSKIs are both highly prevalent and financially burdensome. We observed variation across the Services in the prevalence and incidence of UE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of UE MSKIs on the readiness and overall health of the U.S. Military. [ABSTRACT FROM AUTHOR]

Introduction Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs. Materials and Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for LE MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHR) from military treatment facilities (MTFs), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository (MDR) from October 1, 2015 to September 30, 2021 (FY16–21). Utilization associated with LE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to LE MSKIs were captured for each year. Results In FY21, LE MSKIs occurred in 25.3% of ADSMs (n  = 378,615). A higher proportion of females sustained an LE MSKI (33.3%), compared to males (23.7%). From FY16–21, the Army had the highest annual prevalence of LE MSKIs (30.9–35.5%), followed by the Air Force (23.8–31.0%), Marine Corps (23.4–27.0%), and Navy (17.2–19.8%). Incidence rate patterns were similar, with the Army sustaining LE MSKIs at 320 to 377 injuries per 1,000 person-years, followed by the Air Force (241–318), Marines (255–288), and Navy (173–203). Overuse/non-specific MSKIs of the knee were the most common injury type and body region affected, respectively. There were 10,675,543 DC and 1,875,307 PC outpatient encounters from FY16–21 with a primary or secondary diagnosis of LE MSKI. The Air Force was most reliant on PC, with 21.5 to 36.8% of LE MSKI-related encounters occurring outside MTFs during FY16–21. Over $99 million was paid by TRICARE on LE MSKI in FY21 alone with Same Day Surgeries accounting for almost half ($48 million) of this total. Conclusions Among U.S. ADSMs, LE MSKIs remain highly prevalent and costly. We observed disparities across the Services in the prevalence and incidence of LE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of LE MSKIs on the readiness and overall health of the U.S. Military. [ABSTRACT FROM AUTHOR]

Background Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010–2021, and to quantify and describe associated health care utilization and PC costs over the same period. Methods This study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine (upper back, middle back, lower back, pelvic), and Lower Extremity (LE) MSKIs in ADSMs, associated health care utilization, and PC costs were derived by querying electronic health records from DC, PC claims, and theater medical data from the Military Health System Data Repository. Patient episodes of care and associated PC costs related to MSKIs in DC and PC settings were classified into mutually exclusive outpatient encounter categories and acute inpatient stays, body regions, and Services. Results Over FY10–21, the most prevalent MSKIs were LE (24–29%) followed by Spine (17–20%), UE (14–16%), and Head/Neck (6–8%). Across FY10–21, soldiers were more likely to sustain LE MSKI than Airmen (risk ratio 1.12–1.30) and Marines demonstrated an increasing risk of LE MSKI prevalence and incidence (relative to Airmen) over the study period. The rise in prevalence of LE, Spine, UE, and Head/Neck MSKIs over FY10–21 was accompanied by increased health care utilization and reliance on PC care, especially same-day surgeries (SDS). PC reliance for SDS increased across body regions from FY10 to its peak in FY20 (Head/Neck: 22.7% to 49.7%, Spine: 37.1% to 57.0%, LE: 38.6% to 51.5%, UE: 40.4% to 53.5%). In FY21, the MHS incurred the highest PC costs for LE MSKIs ($132,242,289), followed by Spine ($98,738,863), UE ($92,118,071), and Head/Neck ($42,718,754). Conclusions To our knowledge, this is the first population study of MSKIs in ADSMs spanning the ICD-10 CM transition (FY15–16) that includes the four Services. Across Services, MSKIs in the U.S. military remain a prevalent and persistent problem. Consistent with prior research, the LE was the most common and costly body region affected by MSKIs. Service members with MSKIs demonstrated an increasing reliance on PC for MSKI care, particularly SDS, over the study period. Expanding future research efforts to include all Services to assess risk factors and patient outcomes for treatments across DC and PC settings is vital to mitigate the threat posed by MSKIs to the readiness of the U.S. Armed Forces. [ABSTRACT FROM AUTHOR]

Background Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition. Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Upper Extremity, Lower Extremity, Spine, and Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2010 to September 30, 2021 (Fiscal Years 10-21), using the Military Health System Data Repository. Utilization associated with MSKIs per body region in the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs were captured per year and categorized by service, body region, and setting. Conclusions MSKI surveillance research in ADSMs has been impacted by variable, often incompletely described methods. While our approach is not without limitations, our aim was to present a well-documented, reproducible methodology for MSKI investigation in military personnel. By presenting a comprehensive blueprint for capturing and categorizing MSKI care in U.S. service members, our goal is for this methodology to enhance the efforts of researchers, public health officials, and Military Health System leaders to combat MSKIs, the primary medical threat to military readiness. [ABSTRACT FROM AUTHOR]

Introduction The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS. Materials and Methods We calculated monthly prevalence rates for six diagnostic groupings of MSKIs routinely seen in the MHS between October 2011 and February 2020. To determine if the transition to ICD-10-CM influenced prevalence rates, we performed an interrupted time series analysis, using the ICD-10-CM transition date (October 1, 2015) as the interruption point. To assess trends in direct and private sector care encounters during the MHS GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from November 1, 2015 through September 30, 2021. Results Three diagnoses had a significant (P  < .05) change in the slope, or rate of change, for their monthly prevalence after the introduction of ICD-10-CM (patellofemoral pain syndrome, −0.18; stress fractures, 0.12; subacromial pain, 0.03). These diagnoses also had a significant level change or immediate change in monthly prevalence following the ICD-10-CM transition (patellofemoral pain syndrome, 24.2; stress fractures, 0.16; subacromial pain, 0.36). Three of the four sites adopting MHS GENESIS showed reduced 3-month averages (range: −7.1–13.0%) of MSKI-related encounters following the electronic health record transition. For two of the four MTFs, we observed an increased reliance on private sector immediately leading up to and following the change to MHS GENESIS. Conclusions The observed differences in monthly prevalence for certain MSKIs could be because of the changes in the amount and/or specificity of available codes in ICD-10-CM. Within the six selected diagnostic groupings of MSKIs, we found that patellofemoral pain syndrome, stress fractures, and subacromial pain syndrome demonstrated the greatest changes in prevalence during the ICD-10-CM transition. Those involved in MSKI surveillance should exercise caution when evaluating MSKI prevalence that spans the ICD-10-CM transition. Changes in health care utilization patterns in two of the four MTFs during their adoption of MHS GENESIS suggest that MSKI care may have transferred from direct to private sector care during this period. Future research will be required to validate this finding and determine the impacts on clinical outcomes and military readiness. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSKIs) are highly prevalent and costly conditions among active duty service members (ADSMs), and female service members sustain these injuries at a higher rate than men. However, lack of women-specific research regarding MSKIs in the U.S. military has limited Department of Defense (DoD) leadership from assessing and addressing the burden of these conditions. The purposes of this study were to report the incidence, prevalence, and types of MSKIs sustained by female ADSMs across the four services in direct care (DC) and private sector care (PC) settings from fiscal years (FYs) 2016 through 2021 and to quantify and describe the health care utilization and private sector costs associated with MSKIs in women over the same period. Materials and Methods This retrospective, longitudinal population study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine, and Lower Extremity (LE) MSKIs in female ADSMs, associated health care utilization, and private sector costs were derived by querying electronic health records from military treatment facilities, PC claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16–21). Health care utilization associated with MSKIs among female ADSMs for each body region in DC and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs in service women were captured for each year and categorized by service, body region, and setting. Results In FY21, 10.8% (n  = 27,976) of female ADSMs sustained Head/Neck MSKI, 16.3% (n  = 42,294) UE MSKI, 23.6% (n  = 61,048) Spine MSKI, and 33.3% (n  = 86,235) LE MSKI. Across the study period, female ADSMs had a 25%–29% higher risk of any MSKI (risk ratio (RR) 1.25–1.29) relative to men. Female soldiers had the highest annual prevalence of MSKIs (62.1%–66.4%), while female Marines had the highest risk of MSKI relative to men (RR 1.40–1.47) for all four major body regions. From FY16 to FY21, the body region with the highest risk of MSKI relative to men was Head/Neck (RR 1.61–1.63), while the region with the lowest relative risk was UE (RR 1.05–1.10). LE MSKIs represented the most common and costly type of injury in female ADSMs, with 406,997 outpatient DC and 87,374 PC encounters in FY21. Total PC costs of LE MSKI for female ADSMs were $30,643,535 in FY21 alone. Conclusions This is the first population-level assessment of MSKI prevalence, incidence rates, health care utilization, and PC costs over a 6-year period for service women in the military health system (MHS). Female ADSMs sustain MSKIs at a higher rate than their male counterparts. Given the critical role of service women in the military, MHS leaders, researchers, and public health officials should continue to explore the underlying causes of these disparities in MSKI rates between the sexes, by expanding research efforts to all services and military settings. [ABSTRACT FROM AUTHOR]

Background Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021. Materials and Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Spine MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHRs) from military treatment facilities, private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16–21). Utilization associated with Spine MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Spine MSKIs were captured per year. Results In FY21, 269,301 ADSMs sought care for Spine MSKI, representing 18.0% of the U.S. Armed Forces. The prevalence of Spine MSKIs ranged from 17.4 to 19.5% during FY16–21, with the highest annual prevalence among the Army (20.7–22.9%) and Air Force (19.0–22.6%). Across the study period, Soldiers had the highest share (47.8–50.4%) of DC outpatient encounters for Spine MSKI (primary or secondary diagnosis). The Air Force relied most heavily on PC for outpatient Spine MSKI care across the study period, where in FY21 Airmen accounted for 36.5% of the outpatient PC Spine MSKI encounters totaling $21,140,935 in PC costs. In FY21, total PC costs for Spine MSKI totaled $99,317,832. Conclusions This retrospective, descriptive study establishes prevalence/incidence, health care utilization, and PC costs for Spine MSKIs across the Services from FY16–21 and highlights the burden of Spine MSKIs among the U.S. Armed Forces, with costs amounting to over $99 million in PC reliance in FY21 alone. [ABSTRACT FROM AUTHOR]

Background Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021. Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2015 to September 30, 2021 (FYs 16–21), using the Military Health System Data Repository. Utilization associated with Head/Neck MSKIs in both the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Head/Neck MSKIs were captured for each year. Results In FY21, 109,683 ADSMs sought care for Head/Neck MSKIs, representing 7.3% of the U.S. Armed Forces. The prevalence of Head/Neck MSKIs ranged from 6.9 to 7.8% during FY16–21, with the highest annual prevalence among the Air Force (8.0–9.4%) and Army (7.9–8.8%). Within direct care across the services, Soldiers presented for the highest proportion (45.9–47.9%) of outpatient encounters for Head/Neck MSKI annually. The Air Force relied most heavily on PC for outpatient Head/Neck MSKI care, which accounted for $9,134,741 in PC costs and comprised 37.2% of all PC encounters in FY21. Conclusions This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16–21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone. [ABSTRACT FROM AUTHOR]