Page 100 - JSOM Spring 2025

TABLE 2 Inclusion and Exclusion Criteria
Inclusion Criteria Exclusion Criteria
• Studies conducted in Special Operations Forces military or police • Studies where data included conventional units or other military
units; services (support personnel, logistics, etc.) and Special Operations
• Musculoskeletal injuries reported; Forces data could not be extracted;
• Report injury data with an epidemiological focus, such as the • Traumatic battle-related injuries where noncombat musculoskeletal
number of injuries and types of injuries; injuries could not be extracted;
• Peer review publications with original data collected; and • Studies that only report subset of injuries (e.g., shin pathologies in
specialist police);
• Published in English or translatable to English. • Study design without original data collection; or
• Study reported on mental health or psychological injury.

injured). Once tabulated, the discrepancies in data extracted Demographic Profile of the Articles
were resolved by a third author (M.S.). Naturally emerging The included articles represented work from four countries,
themes were identified and used to categorize the findings for with two target populations and two different categories of
narrative discussion. personnel examined (SOF Operators [i.e., had completed all
specialist training and were operational] or trainees [i.e., were
selected to a specialist unit but were still undergoing specialist
Results
training]). The articles included 16 from the United States 28–43 ;
The results of the search are shown in Figure 1. Initially, 3,773 2 from Australia 44,45 ; and 1 each from the United Kingdom
46
results were identified following the database search, from and France. Regarding target populations, 18 articles related
47
which 652 were removed as duplicates (see Supplementary to military SOF 28–46 and 2 to police specialist units were in-
Table A1). The remaining 3,121 results were then screened by cluded. 45,47 Sixteen articles evaluated MSK injuries sustained
title and abstract. Among them, 3,074 studies clearly not rele- by qualified Operators, 29–39,41,42,44–46 two articles reported in-
vant to the review were removed (e.g., “Perceptions of Simula- juries sustained by both Operators and students, 40,43 and two
tor- and Live Tissue-Based Combat Casualty Care Training of articles reported only student injuries. 28,47 Three studies were
Senior Special Operations Medics,” Bukoski et al.). 27 specific to injuries sustained during military static line para-
chuting, 30,34,44 with one study specific to injuries sustained
The remaining 47 studies were then retrieved, and their full during fast-roping and another specifically examining over-
29
texts were reviewed. Following the application of the inclusion use injuries. 28
and exclusion criteria, 14 eligible publications were retained to
inform this review. Snowball screening of the reference lists of Following data extraction (see Table 3) five naturally occur-
the included studies led to the addition of 6 studies, bringing ring MSK injury themes were identified to inform this re-
the number of eligible studies to 20. view. These themes were: 1) incidence in SOF populations;

FIGURE 1 PRISMA flow diagram showing literature search, screening, identification of additional studies and eligibility results.
Identification of studies via databases and registers Identification of studies via other methods

Records identified from*: Duplicate records
Identification • (Web of Science, n=447) (Using Endnote, n=632) Records identified from
• Databases (n=3,773)
removed (n=652)
citation searching
• (ProQuest, n=1,862)
(n=8)
• (Embase, n=1,020)
(Manually, n=20)
• (PubMed, n=444)
Records screened Records excluded as
(n=3,121) clearly not relevant
(n=3,074)

Reports sought for retrieval Reports not retrieved Reports sought for retrieval Reports not retrieved
Screening (n=47) (n=0 ) (n=8) (n=0)

Reports assessed for eligibility Reports excluded, with reasons (n=33): Reports sought for retrieval Reports excluded:
(n=47) • Conventional units or other personnel (n=8) • Not peer reviewed (n=1)
included and SOF data that could not be • Other personnel included
extracted (n=16) and SOF data could not be
• Traumatic battle-related injuries (n=0) extracted (n=1)
• Only reported subset of injuries (n=11)
• No original data collection (n=5)
Included Studies included in review • Studies on mental health or psychological SOF = Special Operations Forces.
injuries (n=1)
(n=20)

98 | JSOM Volume 25, Edition 1 / Spring 2025