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U.S. Army Ranger School is an arduous 64-day leadership training course designed to simulate the stressors of combat. Although physical fitness has been shown to be an important predictor of successful graduation for Ranger School, psychosocial characteristics like self-efficacy and grit have not been examined. The purpose of this study is to identify personal, psychosocial, and fitness characteristics associated with successful completion of Ranger School. This study was a prospective cohort examining the association of baseline characteristics of Ranger School candidates with a primary outcome of graduation success. Multiple logistic regression was performed to determine the contribution of demographics, psychosocial, fitness and training characteristics to graduation success. Out of 958 eligible Ranger Candidates, this study obtained graduation status for 670 students, 270 (40%) of which graduated. Soldiers who graduated were younger, more likely to come from units with a higher proportion of previous Ranger School graduates, had higher self-efficacy and faster 2-mile run times. The results from this study suggest that Ranger students should arrive in optimal physical conditioning. Furthermore, training programs that optimize student self-efficacy and units with a high proportion of successful Ranger graduates may confer advantage for this challenging leadership course. [ABSTRACT FROM AUTHOR]

Introduction: Neuromusculoskeletal injuries (NMSKIs) are the primary cause of ambulatory visits, lost duty days, and disability discharges in the U.S. Military. Methods for accurately grouping injury diagnoses are required to allow for surveillance and research identifying risk factors and prevention strategies. The CDC method of grouping these diagnoses includes only the S and T codes (Injury, poisoning, and certain other consequences of external causes) from the ICD-10-CM. However, this does not include the majority of the NMSKI depleting soldier readiness; the M (Disease of the musculoskeletal system and connective tissue) and G (Diseases of the nervous system) codes should be included as these also contain injuries. The goal was to develop a new matrix that would comprehensively capture all NMSKIs experienced by military personnel. This paper details the development of the Occupational Military Neuromusculoskeletal Injury (OMNI) Matrix and characterizes the number and rates of active duty U.S. Army injuries as measured by the OMNI compared to other matrices.Materials and Methods: A team of researchers including physical therapists, physician assistants, occupational therapists, physicians, and epidemiologists developed the OMNI. The OMNI utilizes the commonly accepted injury definition inclusive of any anatomical complaint resulting in pain or dysfunction and categorizes injuries from the G, M, S, and T codes. The OMNI follows the CDC's matrix structure with three body region levels, each becoming more specific, and adds two levels called Description of the Injury. Additionally, the OMNI categorizes injuries as Injury Type (Acute, Overuse, Either, or Not Applicable), NMSKI-Type (NMSKI, NMSKI that could be caused by occupational/training tasks, and not an NMSKI), and a miscellaneous category that demarks injuries as Superficial, Blood Vessels, and/or Internal Organs. The different grouping methods in the OMNI provide standardization for many possible injury case definitions. The OMNI allows these injury categories to be included/excluded in a standardized fashion to meet the researchers' scientific questions. To enumerate the number of NMSKI that would be captured by the available matrices, the OMNI, the CDC's matrix, and the U.S. Army Public Health Center's (APHC) Taxonomy of Injuries were applied to active duty Army outpatient population data and all incident NMSKI diagnostic codes entered in electronic medical provider encounters for calendar years 2017 and 2018.Results: Using the OMNI resulted in the capture of over 800,000 more injuries than the CDC's matrix and over 200,000 more than the APHC Taxonomy. The NMSKI rate utilizing the OMNI was 193 per 100 soldier-years in 2017 (892,780 NMSKI) compared to 23 per 100 soldier-years for the CDC's matrix, and 141 per 100 soldier-years for the APHC Taxonomy.Conclusion: The OMNI provides an updated standardized method of assessing injuries, particularly in occupational military injury research, that can be utilized for Military Performance Division of injury across many countries and still allow for replication of methods and comparison of results. Additionally, the OMNI has the capacity to capture a greater burden of injury beyond what is captured by other available matrices. [ABSTRACT FROM AUTHOR]

Introduction: Neuromusculoskeletal injuries (MSKI) are the leading cause of medical encounters, lost or limited duty days, medical evacuations, and disability in the U.S. Army. In the U.S. Army, objective MSKI incidence rate metrics can be determined through medical encounter data (M2SKIs) with International Classification of Diseases (ICD) 9 and ICD 10 codes or through documented limited duty profiles (LDPs) documenting time-loss MSKI (TLMSKI). The purpose of the current study was to characterize the population incidence of TLMSKIs among U.S. Army soldiers.Materials and Methods: This study was approved by the Medical Research and Development Command's Institutional Review Board. This was a retrospective population-level study. The U.S. Army's eProfile system was utilized to characterize all LDPs issued during 2017-2018 and to describe the body regions injured and activities associated with these TLMSKIs.Results: The incidence rate of TLMSKIs was found to be 44 and 40 TLMSKI/100 soldier-years for 2017 and 2018, respectively, which is lower than previously published incidence rates using MSKI receiving medical care. Approximately one quarter of the total active duty Army population in 2017 and 2018 recorded limited duty injuries, where those to the ankle/foot region resulted in the most LDPs and those to the knee resulted in the most lost duty days. The majority of all TLMSKIs were associated with fitness training-related activities.Conclusion: This descriptive study is the first to present the U.S. Army population rates for MSKIs that result in LDPs, representing key time losses when soldiers cannot participate in their military occupational and physical training tasks. This study utilizes the LDP system to calculate limited duty days instead of attempting to estimate this information from other means. The eProfile system is limited in that it combines body regions such as ankle/foot and does not allow isolation of ankle or foot independently. It is recommended that research and training programs target the identification, development, and validation of effective and scaleable strategies to maximize performance without severely reducing combat effectiveness because of training TLMSKIs. [ABSTRACT FROM AUTHOR]

The US militaries are in the process of opening previously closed combat military occupations to women. This will result in women engaged in occupations with high physical demands. The purpose of this prospective cohort study was to investigate if changes in occupational physical demands between garrison (home duty station) and deployment to a combat area were related to musculoskeletal injuries (MSI) in female soldiers. Participants were recruited from three brigade combat teams deploying to Afghanistan for nine months. A total of 160 female soldiers completed surveys on occupational demands just prior to deployment. After returning from deployment, soldiers completed the same survey on occupational demands and additional questions on MSI sustained while deployed. The following physical demands all increase significantly between garrison and deployment: hours spent wearing body armour, sitting, wearing the average load, and wearing the heaviest load; the weight of the heaviest load worn; and the average number of times objects were lifted (p<0.05). The increases in hours wearing the average (Odds Ratio 1.1) and heaviest load (OR 1.1) as well as the weight of the heaviest load (OR 1.03) and the number of lifting repetitions (OR 1.1) were all predictive of MSI in the deployed female soldiers. Rapid increases in physical demands from garrison to deployment resulted in injury. Military units should gear physical training prior to deployment specifically towards their occupational tasks such as the weight of the load worn and the time spent wearing it while incorporating a gradual increase in physical demands. [ABSTRACT FROM AUTHOR]