Page 74 - JSOM Fall 2021

Self-Reported Musculoskeletal Injury Healthcare–Seeking

Behaviors in US Air Force Special Warfare Personnel

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Brittany Hotaling, MS *; Justin Theiss, DPT, DSc ; Bruce Cohen, PhD ;
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Kristen Wilburn, DPT ; Jennifer Emberton, DPT ; Richard Westrick, DPT, DSc 6
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ABSTRACT
Purpose: This study evaluated the musculoskeletal injury approximately 42% or $440,000 of that assessment attributed
(MSKI) self-reporting behaviors among active-duty Air Force to potentially preventable MSKIs. 13
Special Warfare personnel to explore potential limitations of
injury surveillance approaches. Methods: Participants com- Many injuries are an unfortunate consequence of Service-
pleted a 47-item survey between December 2018 and March members (SMs) preparing for and executing the physically de-
2019 regarding their MSKI history. Participants were asked if manding requirements of their occupations. Specific demands
they sought medical care for symptoms consistent with MSKIs vary across service branches, occupational specialties, and op-
and reasons they did or did not report their injuries. Injury erations tempo. The rigors of military service require regular
reporting rates were calculated with descriptive statistics and physical training and testing to ensure an SM is prepared to
rank ordering was utilized to determine frequency. Results: A carry out required tasks during combat. In the US Air Force
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total of 398 airmen reported 1,057 injuries occurring in the (USAF), a fitness test must be passed to qualify for deployment
previous 12-month period, including 508 (48%) injuries iden- and to remain on active status. In addition to military train-
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tified as not reported to medical personnel. Approximately ing–related causes, many of the MSKIs reported are a result
55% (N = 579) of all injuries were described as gradual onset. of sports and recreational activities. 16,17 Copley and colleagues
The most common reason for not reporting injuries (28.8%, reported on 10 years (1993–2002) worth of safety data in the
N = 62) was “fear of potential impact on future career oppor- USAF; their research revealed that sports-related injuries occur
tunities.” Conclusion: Approximately half of MSKIs in this more than 70% of the time on a military installation. Similar
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sample of US Air Force Special Warfare personnel were not to other military populations, airmen may conceal or exagger-
reported to medical personnel. The underreporting of injuries ate these non-battle injuries because of their perceived impact
may pose unknown levels of risk and negatively impact mili- on job performance and due to concern for duty restrictions
tary readiness levels. and lost/limited duty days.

Keywords: underreporting; injury exaggeration; concealment; The accuracy of MSKI reporting across the US military re-
injury rates; symptoms; self-report MSKI; military mains unclear. Injury reporting behaviors, such as injury con-
cealment and injury exaggeration, are potential concerns for
the military. Injury concealment, one reason for not reporting
an injury, occurs when an individual likely has an injury but
Introduction
is unwilling to seek medical care due to concerns the injury
The threat posed by musculoskeletal injury (MSKI) has per- might impact their career or ability to participate in military
sisted as a liability to military readiness for the armed services duties. Injury exaggeration occurs when an individual seeks
for decades. Health reports in 2018 for the US military re- care when they do not truly have an injury, or when they
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vealed that there were over 1.6 million nonbattle injuries, with embellish information about an actual injury. A 2019 study
the majority of those being classified as cumulative traumatic found that nearly 60% of MSKIs in a US Army trainee popu-
injuries. Additionally, in 2017 more than half of active-duty lation were not disclosed to leadership or a medical provider.
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soldiers had reported at least one injury, 70% of which were Reasons for not reporting these injuries centered on a desire to
classified as overuse. The nature of these overuse and cumu- graduate on time and not wanting a profile. Smith and col-
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lative injuries is concerning because they are directly related leagues reported on the behaviors of soldiers from operational
to personnel attrition, long-term disability, and medical and troops in 2016. Data obtained from this anonymous survey
disability discharge. Not only are MSKIs a threat to mili- revealed that 49% of injuries went unreported to medical per-
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tary readiness, but they have become a burden on financial sonnel. The most common reason for not reporting MSKIs
and healthcare resources. 9–12 For example, in 2018, the Army’s was “fear of impact on career” and “avoiding a profile.”
MSKI financial burden alone accounted for $434 million in While the number of unreported injuries was high, only 6% of
direct patient care costs. In an Air Force Special Operations soldiers indicated that they had exaggerated symptoms of an
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cohort, Lovalekar et al. estimated the total lifetime cost for injury to a medical provider. In another study, about 54% of
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MSKIs sustained by 130 Operators to be $1.2 million, with soldiers stated that “they would not immediately seek medical
*Correspondence to brittany.r.hotaling.civ@mail.mil
1 Brittany Hotaling, Dr Bruce Cohen, Dr Jennifer Emberton, and MAJ (Ret) Richard Westrick are affiliated with the US Army Research In-
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stitute of Environmental Medicine in Natick, MA. LtCol Justin Theiss is affiliated with the 8th Operational Medical Readiness Squadron. Dr
Kristen Wilburn is affiliated with US Army Research Institute of Environmental Medicine and the University of South Carolina in Columbia, SC.
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