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Context: Musculoskeletal injuries (MSK-I) are a well-documented problem in military populations and a leading contributor to disability across military services. However, only a portion of Service members who sustain MSK-I report it to medical providers. Although several studies have identified barriers to seeking medical care in military populations, less is known about what motivates Service members to seek care for MSK-I., Objective: To describe determinants of medical care-seeking behavior for MSK-I and/or musculoskeletal pain (MSK-P) in recently-enlisted Marines during military training., Design: Qualitative Study., Setting: School of Infantry-West (SOI-W), US Marine Corps Base XXX, XXX., Patients or Other Participants: 1,097 US Marines entering Infantry Training Battalion or Marine Combat Training at SOI-W., Data Collection and Analysis: Participants completed written surveys at entry to (baseline) and graduation from SOI-W. Closed-ended question responses were used to calculate MSK-I/MSK-P and care-seeking frequencies. Open-ended responses describing determinants of care-seeking behavior were analyzed using inductive thematic analysis., Results: Ten percent of participants self-reported sustaining MSK-I during basic training, while 14% self-reported sustaining MSK-I in SOI-W training. A greater proportion reported seeking medical care for their MSK-I/MSK-P during basic training compared to SOI-W training. The thematic analysis resulted in three main themes that describe drivers and barriers for seeking medical care: 1) Self-perceived need for medical care; 2) Prioritizing military training; and 3) Training-specific influences., Conclusion: Understanding determinants of care-seeking behavior is valuable when designing intervention strategies to promote early MSK-I treatment. Our findings add to previous research to elucidate reasons underlying the decisions about care-seeking for MSK-I/MSK-P. Interventions, including educational strategies and direct approaches, like embedding medical providers within units, to minimize barriers to seeking medical care in the military may reduce the burden of MSK-I/MSK-P on Service members throughout their military careers., Competing Interests: Conflicts of Interest: The authors have no financial interests or relationships to disclose.

Introduction: Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities., Methods: A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified., Results: From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions., Conclusion: Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military., Competing Interests: Competing interests: NA reports grants from Centre for Sport, Exercise & Osteoarthritis Research Versus Arthritis, outside of the submitted work. SdlM reports grants from the Congressionally Directed Medical Research Programme and the Veterans Affairs/Department of Defense Health Affairs Joint Incentive Fund, outside of the submitted work. JJF reports grants from Congressionally Directed Medical Research Programme and the Office of Naval Research, outside of the submitted work. In addition, JJF has a patent pending for an Adaptive and Variable Stiffness Ankle Brace, US Provisional Patent Application No. 63254,474. AR reports grants from the Concussion in Sport Group, Alberta Bone and Joint Strategic Clinical Network, Tonal Strength Institute, outside of the submitted work. DIR reports grants from the Congressionally Directed Medical Research Programme and the National Institutes of Health, outside of the submitted work, and grant support for the submitted work from the Uniformed Services University, Department of Physical Medicine & Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness programme (MIRROR HU00011920011)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)