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Journal of the Royal Army Medical Corps
Journal Prestige (SJR): 0.303
Citation Impact (citeScore): 1
Number of Followers: 6  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0035-8665 - ISSN (Online) 2052-0468
Published by BMJ Publishing Group Homepage  [62 journals]
  • The BMJ Military Health Military Rehabilitation special issue

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      Authors: O'Sullivan, O; Ladlow, P, Coppack, R. J, Bennett, A. N.
      Pages: 253 - 255
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2022-002145
      Issue No: Vol. 168, No. 4 (2022)
       
  • Developing UK Defence Rehabilitation research priorities: a 2020 clinical
           practitioner engagement exercise

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      Authors: Coppack, R. J; Ladlow, P, Bennett, A. N.
      Pages: 256 - 259
      Abstract: IntroductionEstablishing research priorities help to address knowledge gaps and exploit emerging opportunities to develop a clinical evidence base. The previous clinical engagement exercise to determine UK Defence Rehabilitation practitioner-based research priorities was conducted in 2014. The aim of this article is to (1) describe how research priorities are established for UK Defence Rehabilitation; (2) review, reassess and rate the priorities highlighted and set by rehabilitation practitioners following the 2014 survey and (3) identify new rehabilitation research themes and topics reflecting 2020 priorities.MethodsStage 1: delegates (n=72) at the October 2019 Defence Medical Services Rehabilitation Conference participated in a series of focus group workshops. Stage 2: an online survey circulated through the military chain of command to all Defence Primary Health Care clinical rehabilitation staff. Stage 3: a thematic analysis of all survey submissions yielding a ranked order of priority by topic.Results165 clinical rehabilitation staff completed an online survey. ‘Rehabilitation outcomes’, ‘Psychological factors in rehabilitation’ and ‘Residential/Inpatient treatment paradigm’ emerged as three clear research priorities across all three tiers of UK Defence Rehabilitation. New research priorities emerging from the 2020 survey were ‘lifestyle factors during rehabilitation’, ‘management of pain during rehabilitation’ and ‘anterior knee pain’.ConclusionIt is essential that funding directed to musculoskeletal rehabilitation focuses on the highest research priorities in the field to ensure optimum health return on investment. The results of this survey will assist in guiding the clinical research being conducted within UK Defence Rehabilitation over the next five years.
      Keywords: Editor''s choice
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001676
      Issue No: Vol. 168, No. 4 (2022)
       
  • Musculoskeletal complaints in military recruits during their basic
           training

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      Authors: Keijsers, N. L. W; ter Stal, M, Jonkergouw, N, Helmhout, P. H.
      Pages: 260 - 265
      Abstract: IntroductionOveruse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries in military recruits. This study describes the musculoskeletal complaints in Dutch military recruits during their basic training and examines potential predictive factors for dropout due to injury.MethodsIn this prospective cohort study, Dutch military recruits reported complaints of the lower body weekly using a Numeric Rating Scale (NRS) pain score chart during their basic training. Number, location and severity of complaints during each of the first 12 weeks of basic training were analysed.ResultsOf the 930 recruits, 61% reported an NRS pain score of 3 or higher and 34% reported an NRS pain score of 5 or higher at least once. Complaints were mostly reported in the foot and ankle region and least reported in the upper leg region. Injury dropouts (11%) showed significantly higher proportions of complaints and higher maximal pain scores throughout most weeks of basic training. The maximal NRS pain score of the first two weeks was the strongest predictor of dropping out due to injury.ConclusionsRecruits who drop out due to injury report more severe complaints throughout basic training. Focusing on musculoskeletal complaints in the first phase of training seems helpful to identify recruits who are at risk of developing an injury.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001461
      Issue No: Vol. 168, No. 4 (2022)
       
  • Biomechanical and clinical outcomes in response to inpatient
           multidisciplinary hip and groin rehabilitation in UK military personnel

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      Authors: Allan, R; Cassidy, R. P, Coppack, R. J, Papadopoulou, T, Bennett, A. N.
      Pages: 266 - 272
      Abstract: IntroductionHip and groin related pain is a common complaint among the military population across UK Defence Rehabilitation and addressing associated biomechanical dysfunction is a key treatment goal. Personnel are exposed to complex occupational loads, therefore assessing movement during demanding tasks may expose biomechanical deficits. Observing biomechanical and clinical outcomes in response to treatment is therefore an important consideration. The aims were to examine clinical and biomechanical outcomes prior to (T1) and 12 weeks post (T2) inpatient rehabilitation and explore the influence of pathological subgroup.MethodsProspective cohort study as part of a clinical service evaluation of 25 patients undergoing treatment for hip and groin related pain. Three-dimensional motion capture (3DM) during a single-leg squat, hip strength and patient-reported outcome measures were collected at T1 and T2.ResultsIncreased abductor and external rotator strength with reductions in contralateral pelvic drop (1.9°; p=0.041) at T2 on the injured side. Pain reduced by 9.6 mm (p=0.017) but no differences were found for Non-Arthritic Hip Score (NAHS). No statistically significant differences were found between pathological subgroups. Kinematic profiles display variation between diagnostic subgroups and response to treatment.ConclusionStrength and pain improved with treatment in this service evaluation although biomechanical adaptation and NAHS remain inconclusive. Small and uneven sample size prevents a firm conclusion regarding the effect of pathological subgroupings, however, the data can be considered hypothesis generating for future, larger studies to integrate 3DM for monitoring response to rehabilitation in pathological subgroups to support clinical decision making.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001588
      Issue No: Vol. 168, No. 4 (2022)
       
  • The test-retest reliability of the Military Physical Loading Questionnaire
           (MPLQ)

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      Authors: Coppack, R. J; Bilzon, J. L, Wills, A. K, Papadopoulou, T, Cassidy, R. P, Nicol, A. M, Bennett, A. N.
      Pages: 273 - 278
      Abstract: IntroductionDespite the high prevalence of musculoskeletal injuries, there is a shortage of data quantifying the risk factors attributable to cumulative occupational demands among UK Military personnel. We developed a new comprehensive questionnaire that examines occupational and operational physical loading during military service. The aim of this study was to examine the test–retest reliability of the Military Physical Loading Questionnaire (MPLQ).MethodsIntraclass correlation coefficients (ICC) were used to evaluate the test–retest reliability (4-week interval) of the MPLQ on 18 occupational and 18 operational items in 50 male (mean age: 36 years; SD ±7.9) UK military personnel. A stratified analysis based on duration of Service (0–10 years, 11–20 years and ≥21 years) was conducted to assess whether stability of task items was dependent on participant length of recall. Internal consistency was assessed by Cronbach’s alpha (α) coefficients.ResultsReliability of individual operational items ranged from fair to almost perfect agreement (ICC range: 0.37–0.89; α range: 0.53–0.94) with most items demonstrating moderate to substantial reliability. Overall scores related to occupational items showed substantial to almost perfect agreement between administrations (ICC range: 0.73–0.94; α range: 0.84–0.96). Stratifying by duration of Service showed similar within group reliability to the entire sample and no pattern of decreasing or increasing reliability with length of recall period was observed.ConclusionsIt is essential that data used in planning UK military policy and health services are as accurate as possible. This study provides preliminary support for the MPLQ as a reliable self-report instrument for assessing the cumulative lifelong effects of occupational loading in UK military personnel. Further validation studies using larger and more demographically diverse military populations will support its interpretation in future epidemiological research.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001404
      Issue No: Vol. 168, No. 4 (2022)
       
  • Use of an isometric mid-thigh pull test during musculoskeletal
           rehabilitation: can the criterion values from the updated British Army
           physical employment standards be used to inform UK Defence Rehabilitation
           practice'

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      Authors: Walters, V; Coppack, R, Cassidy, R, Suffield, C, Papadopoulou, T, Bilzon, J, Ladlow, P.
      Pages: 279 - 285
      Abstract: IntroductionObjective outcome measures that can quantify the force generating capacity of the lower limb are required to allow clinicians to accurately measure functional status and treatment adaptations over time. The aim of this prospective observational cohort study is to: (1) evaluate the acceptability of the isometric mid-thigh pull (IMTP) test as a measure of functional strength with military personnel undergoing residential hip pain rehabilitation; (2) compare the peak force values recorded against the updated Army physical employment standards (PES) assessment criteria and (3) assess if the minimum PES required of military personnel has the potential to inform clinical decision making and return to duty criteria within UK Defence Rehabilitation.MethodsAcceptability was assessed against patient’s adherence to the testing procedures and test burden. Clinician acceptability was assessed against ease of administration and safety of test procedure. Hip pain was recorded before, immediately following and 1 hour after testing. Net peak force was recorded using portable force plates.ResultsFull patient and clinician acceptability to IMTP testing procedures were demonstrated. Minimal changes in visual analogue scale (VAS) pain scores were demonstrated between baseline values at rest and follow-up. Despite being medically downgraded and functionally compromised due to chronic hip pain, 100% of patients met the PES expected on entry to the British Army and 79% met the PES expected at the end of basic training.ConclusionThe IMTP provides rehabilitation clinicians with an objective quantifiable measure of maximum muscle strength that can be used early in the rehabilitation care pathway. Based on our finding, it is unclear if the current British Army PES can be used as a criterion standard in Defence Rehabilitation. Therefore, further research focused on generating clinically relevant patient-specific IMTP score criteria, with a larger sample of diverse diagnostic sub-groups is required.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001950
      Issue No: Vol. 168, No. 4 (2022)
       
  • Pectoralis major injuries in the military: a surveillance approach to
           reduce an underestimated problem

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      Authors: Hauschild, V. D; Grier, T, Schuh-Renner, A, Forrest, L. J, Hirleman, C. E, Pinyan, E, Jones, B. H.
      Pages: 286 - 291
      Abstract: IntroductionMultiple studies report increasing cases of surgically treated pectoralis major (PM) muscle and tendon ruptures in military populations. Studies associate this with a growing popularity of weight-training and bench press exercises. Mild-to-moderate non-surgical PM traumas and overuse injuries have not been included in these studies despite evidence that these types of outpatient injuries account for the majority of the military’s injury medical burden.MethodsTo assess rates of all PM injuries (ruptures, tears, strains, overuse), regardless of form of treatment, a PM injury surveillance definition was derived from International Classification of Disease (ICD) diagnostic codes used in routine US Army injury surveillance. A detailed clinical examination of 2016 Active Duty Army medical records was used to identify ICD codes commonly associated with PM injuries. Cost data were calculated and the definition applied to medical data from 2016 through 2018to assess trends.ResultsThe estimated incidence of PM cases among soldiers was over 95% greater than if only considering severe surgical cases. Over 96% of army annual PM injury costs (direct medical and indirect from lost labour) were for outpatient services. PM injury incidence rates were not statistically different from 2016 to 2018.ConclusionsThe PM injury surveillance definition provides a consistent means to monitor trends over time and evaluate the effectiveness of prevention efforts. PM injuries have a larger military impact than previously recognised and prioritised prevention strategies are needed to reduce them. Future interventions could focus on the bench press given its observed association with PM injuries.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001648
      Issue No: Vol. 168, No. 4 (2022)
       
  • The influence of pain, kinesiophobia and psychological comorbidities on
           the accuracy of rating of perceived exertion in UK military spinal
           rehabilitation

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      Authors: Conway, D; Bliss, A, Patterson, S. D.
      Pages: 292 - 298
      Abstract: IntroductionChronic low back pain (CLBP) is a leading cause of disability in the UK Military. Pain and psychological comorbidities have been reported to influence the rating of perceived exertion (RPE). Exercise rehabilitation can be monitored using RPE; however, the accuracy of RPE in inpatient CLBP rehabilitation is unknown.MethodsA prospective cohort correlation study of 40 UK Military inpatients with CLBP was completed. Disability (ODI), kinesiophobia (TSK), anxiety (GAD-7) and depression (PHQ-9) were subjectively reported at the beginning and end of a 3 week intervention. Pain (VAS) and HR were recorded in the first aerobic exercise (AE) session (T1) and the final aerobic exercise session (T2). RPE was reported for each AE session.ResultsAt T1, a positive correlation was observed between RPE accuracy (–7.2±20.9), and pre-exercise pain (2.7 mm ±1.6 mm) (p>0.001) and ODI (31.0±16.9) (p>0.05), and a negative relationship between RPE accuracy and average HR (135 bpm ±22 bpm) (p>0.001) was observed. At T2, there was no significant correlation between RPE accuracy (–4.4±22.6) and pre-exercise pain (2.8 mm ±1.6 mm) or ODI (34.0±16.5) (p>0.05). The strong negative relationship between RPE accuracy and average HR (137 bpm ±20 bpm) remained at T2. Improved RPE accuracy over the 3-week rehabilitation programme was correlated to the change in average HR (r=–0.314, p
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001797
      Issue No: Vol. 168, No. 4 (2022)
       
  • Factors associated with low back pain in air force fighter pilots: a
           cross-sectional study

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      Authors: Gomes, S. R. A; Mendes, P. R. F, Costa, L. D. O, Bulhoes, L. C. C, Borges, D. T, Macedo, L. B, Brasileiro, J.
      Pages: 299 - 302
      Abstract: IntroductionLow back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions.MethodsThis is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors.ResultsIt was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both).ConclusionThere was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001851
      Issue No: Vol. 168, No. 4 (2022)
       
  • Clinical application of foot strike run retraining for military service
           members with chronic knee pain

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      Authors: Mazzone, B; Yoder, A, Condon, R, Farrokhi, S.
      Pages: 303 - 307
      Abstract: IntroductionMilitary training is associated with a high incidence of knee pain. Conversion from a rearfoot to non-rearfoot strike during running is effective at reducing knee pain in research environments. The purpose of this report was to demonstrate run retraining as a clinical intervention for service members with knee pain.MethodsSixteen service members with running-related chronic knee pain underwent run retraining that converted foot strike from a rearfoot to a non-rearfoot strike using real-time visual feedback. The Lower Extremity Functional Scale (LEFS) and Numerical Pain Rating Scale (NPRS) for knee pain during running were assessed pretraining, at the final training session and at a 1-month follow-up. During running, foot inclination angle and vertical ground reaction force (VGRF) average loading rate were measured pretraining and at 1 month of follow-up.ResultsService members underwent 7.4±1.0 training sessions over the course of 15.8±4.6 days. LEFS improved by 8±6 points immediately after retraining, with an overall improvement of 10±6 points from pretraining to 1-month follow-up (p
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001789
      Issue No: Vol. 168, No. 4 (2022)
       
  • Effectiveness of virtual reality-based gait education in enhancing the
           rehabilitation outcomes of injured military personnel

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      Authors: Houston, A. D; Coppack, R. J, Bennett, A. N.
      Pages: 308 - 313
      Abstract: IntroductionCorrecting adverse biomechanics is key in rehabilitating musculoskeletal injuries. Verbal instruction remains the primary method for correcting biomechanics and therefore a patient’s understanding of these instructions is believed to directly influence treatment outcomes. The aim of this study was to establish the patients’ perceptions of virtual reality-based gait education (VR-GEd) and to assess its influence on the standard military rehabilitation outcomes.MethodsA retrospective analysis using routinely collected data was performed. Twenty patients with lower-limb musculoskeletal injuries undertook a VR-GEd session on the commencement of a 3-week, multidisciplinary, inpatient course of rehabilitation. Patient outcomes were compared with a group of matched controls, completing the same standardised course of inpatient treatment.ResultsThe VR-GEd group exhibited greater reductions the interference pain had on their mood (p=0.022). Improvements in generalised anxiety (p=0.029) were greater in the VR-GEd group but were not large enough to be clinically meaningful. VR-GEd did not influence functional outcomes. Patients rated the sessions highly in terms of enjoyment and perceived value. Patient feedback highlighted that they understood their injury better and felt the session could positively influence their recovery.ConclusionVR-GEd was proven to be an enjoyable and valued means of educating military inpatients about their injury mechanics. This study found no contraindications for the inclusion of VR-GEd in current rehabilitation programmes. However, current evidence suggests a single VR-GEd session cannot act as a replacement for biofeedback interventions, due to the lack of enhanced improvement across rehabilitation outcomes.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001581
      Issue No: Vol. 168, No. 4 (2022)
       
  • Integration of strength training into UK Defence Rehabilitation practice:
           current trends and future challenges

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      Authors: Ladlow, P; Conway, D, Hayhurst, D, Suffield, C, Cassidy, R, Coppack, R.
      Pages: 314 - 319
      Abstract: The use of strength and conditioning (S&C) in musculoskeletal rehabilitation has gained wide acceptance among the rehabilitation community. However, there is an absence of evidence demonstrating how to best integrate the principles of S&C into rehabilitation practice. This article discusses four broad themes: (1) an overview of the UK Defence Rehabilitation care pathway, (2) the historical and current approaches to physical training to support operational readiness of the British Armed Forces, (3) the current and future challenges of integrating S&C into Defence Rehabilitation practice and (4) research priorities relating to the use of S&C in Defence Rehabilitation. We detail the importance of strength/power-based physical attributes within our military population. We recommend that consideration be given to the benefits of an alternative education/coaching-based model to be used during the current 3-week residential care pathway, which aims to ensure effective implementation of therapeutic S&C over a longer period of care.
      Keywords: Open access
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001590
      Issue No: Vol. 168, No. 4 (2022)
       
  • Neurological rehabilitation following heat illness in the UK Armed Forces

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      Authors: Wilkins, D; O'Sullivan, O, Sayer, J, Penny, L, Roiz de Sa, D, Ellis, H, Dharm-Datta, S.
      Pages: 320 - 323
      Abstract: Heat illness remains a significant threat to health in the UK Armed Forces despite recent improvements in the prevention of cases. A small number of heat illness survivors develop long-term neurological sequelae. Here we briefly review the background literature and present our experience of treating UK Armed Forces patients with neurological consequences of heat illness. In our cohort of patients, we observed significant improvements in subjective symptoms and objective assessments following a period of neurological rehabilitation at the Defence Medical Rehabilitation Centre. We conclude with recommendations for further research and for the incorporation of screening for neurological disability following heat illness into service policy.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2020-001602
      Issue No: Vol. 168, No. 4 (2022)
       
  • Review of neurological rehabilitation for Multiple Sclerosis in the
           British Military

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      Authors: O'Sullivan, O; Allsopp, L, Mitchell, J, Price, L, Tourle, K, Ellis, H.
      Pages: 324 - 328
      Abstract: Multiple sclerosis (MS) is a progressive neurological disorder, classically presenting in working age adults, including those in the Armed Forces. The Defence Medical Rehabilitation Centre (DMRC) Stanford Hall offers vocationally focused neurorehabilitation services for service personnel (SP) with MS, with the goal to minimise disability, maximise independence and remain able to work.This paper has two aims. First, it briefly provides a clinical update of MS, focusing on pathology, presentation, diagnosis and management. Finally, it will describe the role of DMRC and data from the last decade in the management of MS.Our findings suggest not all SP with MS are being referred to DMRC, and some of those who do have significant delays, potentially impacting on patient support, symptom management and occupational outcomes. It is hoped that this paper will improve awareness and recognition of MS for Armed Forces personnel.
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001852
      Issue No: Vol. 168, No. 4 (2022)
       
  • Integrating blood flow restriction with low-load resistance exercise in a
           UK specialist military primary care rehabilitation facility

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      Authors: Hayhurst, D; Coppack, R. J, Ingram, C, Conway, D, Cassidy, R. P, Ladlow, P.
      Pages: 329 - 330
      PubDate: 2022-07-22T09:09:03-07:00
      DOI: 10.1136/bmjmilitary-2021-001897
      Issue No: Vol. 168, No. 4 (2022)
       
 
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