Telehealth services complement in-person neurologic care. The American Academy of Neurology supports patient access to telehealth services regardless of location, coverage for telehealth services by ...all subscriber benefits and insurance, equitable provider reimbursement, simplified state licensing requirements easing access to virtual care, and expanding telehealth research and quality initiatives. The roles and responsibilities of providers should be clearly delineated in telehealth service models.
Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered. Injury-related ...musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance. The purpose of this analysis was to determine the incidence of injury-related musculoskeletal conditions in the military services (2006) and describe a standardized format in which to categorize and report them.
The subset of musculoskeletal diagnoses found to be injury-related in previous military investigations was identified. Musculoskeletal injuries among nondeployed, active duty service members in 2006 were identified from military medical surveillance data. A matrix was used to report and categorize these conditions by injury type and body region.
There were 743,547 injury-related musculoskeletal conditions in 2006 (outpatient and inpatient, combined), including primary and nonprimary diagnoses. In the matrix, 82% of injury-related musculoskeletal conditions were classified as inflammation/pain (overuse), followed by joint derangements (15%) and stress fractures (2%). The knee/lower leg (22%), lumbar spine (20%), and ankle/foot (13%) were leading body region categories.
When assessing the magnitude of the injury problem in the military services, injury-related musculoskeletal conditions should be included. When these injuries are combined with acute traumatic injuries, there are almost 1.6 million injury-related medical encounters each year. The matrix provides a standardized format to categorize these injuries, make comparisons over time, and focus prevention efforts on leading injury types and/or body regions.
Three systematic reviews were conducted on: (i) the history of mouthguard use in sports; (ii) mouthguard material and construction; and (iii) the effectiveness of mouthguards in preventing orofacial ...injuries and concussions. Retrieval databases and bibliographies were explored to find studies using specific key words for each topic. The first recorded use of mouthguards was by boxers, and in the 1920s professional boxing became the first sport to require mouthguards. Advocacy by the American Dental Association led to the mandating of mouthguards for US high school football in the 1962 season. Currently, the US National Collegiate Athletic Association requires mouthguards for four sports (ice hockey, lacrosse, field hockey and football). However, the American Dental Association recommends the use of mouthguards in 29 sports/exercise activities. Mouthguard properties measured in various studies included shock-absorbing capability, hardness, stiffness (indicative of protective capability), tensile strength, tear strength (indicative of durability) and water absorption. Materials used for mouthguards included: (i) polyvinylacetate-polyethylene or ethylene vinyl acetate (EVA) copolymer; (ii) polyvinylchloride; (iii) latex rubber; (iv) acrylic resin; and (v) polyurethane. Latex rubber was a popular material used in early mouthguards but it has lower shock absorbency, lower hardness and less tear and tensile strength than EVA or polyurethane. Among the more modern materials, none seems to stand out as superior to another since the characteristics of all the modern materials can be manipulated to provide a range of favourable characteristics. Impact studies have shown that compared with no mouthguard, mouthguards composed of many types of materials reduce the number of fractured teeth and head acceleration. In mouthguard design, consideration must be given to the nature of the collision (hard or soft objects) and characteristics of the mouth (e.g. brittle incisors, more rugged occusal surfaces of molars, soft gingiva). Laminates with different shock absorbing and stress distributing (stiffness) capability may be one way to accommodate these factors.Studies comparing mouthguard users with nonusers have examined different sports, employed a variety of study designs and used widely-varying injury case definitions. Prior to the 1980s, most studies exhibited relatively low methodological quality. Despite these issues, meta-analyses indicated that the risk of an orofacial sports injury was 1.6-1.9 times higher when a mouthguard was not worn. However, the evidence that mouthguards protect against concussion was inconsistent, and no conclusion regarding the effectiveness of mouthguards in preventing concussion can be drawn at present. Mouthguards should continue to be used in sport activities where there is significant risk of orofacial injury.
The Military Training Task Force of the Defense Safety Oversight Council chartered a Joint Services Physical Training Injury Prevention Working Group to: (1) establish the evidence base for making ...recommendations to prevent injuries; (2) prioritize the recommendations for prevention programs and policies; and (3) substantiate the need for further research and evaluation on interventions and programs likely to reduce physical training-related injuries.
A work group was formed to identify, evaluate, and assess the level of scientific evidence for various physical training-related injury prevention strategies through an expedited systematic review process. Of 40 physical training-related injury prevention strategies identified, education, leader support, and surveillance were determined to be essential elements of a successful injury prevention program and not independent interventions. As a result of the expedited systematic reviews, one more essential element (research) was added for a total of four. Six strategies were not reviewed. The remaining 31 interventions were categorized into three levels representing the strength of recommendation: (1) recommended; (2) not recommended; and (3) insufficient evidence to recommend or not recommend.
Education, leadership support, injury surveillance, and research were determined to be critical components of any successful injury prevention program. Six interventions (i.e., prevent overtraining, agility-like training, mouthguards, semirigid ankle braces, nutrient replacement, and synthetic socks) had strong enough evidence to become working group recommendations for implementation in the military services. Two interventions (i.e., back braces and pre-exercise administration of anti-inflammatory medication) were not recommended due to evidence of ineffectiveness or harm, 23 lacked sufficient scientific evidence to support recommendations for all military services at this time, and six were not evaluated.
Six interventions should be implemented in all four military services immediately to reduce physical training-related injuries. Two strategies should be discouraged by all leaders at all levels. Of particular note, 23 popular physical training-related injury prevention strategies need further scientific investigation, review, and group consensus before they can be recommended to the military services or similar civilian populations. The expedited systematic process of evaluating interventions enabled the working group to build consensus around those injury prevention strategies that had enough scientific evidence to support a recommendation.
ABSTRACTJones, BH and Hauschild, VD. Physical training, fitness, and injurieslessons learned from military studies. J Strength Cond Res 29(11S)S57–S64, 2015—Injuries are the leading cause of medical ...encounters across the U.S. military services resulting in more than 2.0 million clinic visits per year. Almost 50% of military service members experience an injury each year and half of those injuries are caused by physical training (PT), exercise, or sports. To prevent a problem as large and complex as injuries in the military requires a systematic approach. Several key questions must be answered to effectively address a problem such as injuries(1) how big is the problem? (2) what are the causes and risk factors for the problem? (3) do modifiable risk factors for the problem exist? and (4) what works to prevent the problem? The article discusses leading causes of injuries for U.S. Army populations. It then explores key risk factors for exercise and training-related injuries(1) the amounts of training, (2) types of training activities, (3) participants level of fitness, and (4) personal health risk behaviors. The article concludes with a review of prevention strategies illustrating interventions that have been shown to be effective, and others that are not effective. The data presented suggest that PT and exercise cause injuries and that modifications of training are most likely to prevent the problem.
ABSTRACTGrier, T, Brooks, RD, Solomon, Z, and Jones, BH. Injury risk factors associated with weight training. J Strength Cond Res XX(X)000–000, 2020—The purpose of this evaluation was to identify ...injury risk factors associated with weight training (WT). Subjects were 4,785 men and 542 women in a U.S. Army Division. Personal characteristics, unit training, personal training, fitness, and 12-month injury history were obtained by an electronic survey. Risk factors for WT injuries were explored using backward stepping multivariable logistic regression. Risk ratios, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated for each risk factor. Over a one-year period, 4.5% of men and 0.6% of women experienced a WT injury. Weight-training injury incidence was 0.31 and 0.05 per 1,000 hours of WT for men and women, respectively. Overall, men were 7.4 times more likely to experience a WT injury compared with women. For men who participated in WT, independent risk factors for a WT injury included older age (OR 23–27/≤ 22 years = 1.99, 95% CI 1.22–3.27; OR >28/≤ 22 years = 2.48, 95% CI 1.52–4.03) and higher amounts of personal WT per week (OR 60–165/≥ 166 minutes = 0.58, 95% CI 0.39–0.88; and OR 15–59/≥ 166 minutes = 0.40, 95% CI 0.24–0.66). A linear trend was revealed indicating an increasing risk of a WT injury with greater amounts of time spent WT per week (p < 0.01). Performing moderate amounts of WT may reduce the risk of experiencing a WT injury. However, because muscle strength is an important component of fitness for Soldiers, specialized WT programs that improve strength while minimizing injury risks are needed.
Introduction In basic combat training, women experience twice as many injuries as men; however, evidence at the operational Army level is limited. This study aims to investigate the association ...between gender and injury likelihood while controlling for certain confounding factors in the operational Army. Methods Data were analyzed in 2015 from a cross-sectional study utilizing data from a 2010–2011 survey of light infantry Army Soldiers. Gender, age, body fat, tobacco use, Army Physical Fitness Test (2-mile run, push-ups, and sit-ups), occupational physical demand, and injury data were obtained via paper survey. ORs and 95% CIs from a multivariable analysis were calculated. Results Surveys were completed by 4,384 male and 363 female Soldiers. Injury incidence was 42% for men and 53% for women. After adjusting for the aforementioned variables, injury likelihood was higher in Soldiers aged ≥27 years (OR age 27–29/22–26 years=1.26, 95% CI=1.07, 1.48; OR age ≥30/22–26 years=1.28, 95% CI=1.08, 1.51), Soldiers with body fat ≥23.38% (OR body fat ≥23.38%/≤19.28%=1.30, 95% CI=1.08, 1.57), and Soldiers with the slowest 2-mile run times (OR ≥15.68/≤14.13 minutes=1.53, 95% CI=1.26, 1.85). Women were no more likely than men to sustain an injury. Conclusions When accounting for age, body fat, physical performance, and occupational physical demand, there was no gender difference in the likelihood of injury among Soldiers. Although women, on average, have lower aerobic and muscular performance than men, results suggest men and women of similar physical performance experience similar injury likelihood.
Vaping, Smoking, and the Physical Fitness of Active Young Men Dinkeloo, Eero; Grier, Tyson L.; Brooks, Raina D. ...
American journal of preventive medicine,
January 2020, 2020-01-00, 20200101, 2020-01-01, Letnik:
58, Številka:
1
Journal Article
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Adverse effects of cigarette smoking on physical performance are well studied. Because of the recent rise in popularity of vaping, it is important to evaluate its effect on fitness both independently ...and in conjunction with traditional cigarette use.
This was a secondary analysis performed in 2018 on data collected from U.S. Army Soldiers during 2016. All metrics were self-reported via an electronic questionnaire. Personal characteristics of current ENDS users, smokers, and dual users were compared with a reference group that reported no history of use. Adjusting for age and physical training habits, an ANCOVA was used to compare Army physical fitness test results. A Fisher's exact test determined specific mean differences between groups.
This study population consisted of 2,854 men aged 24.6 years on average. Differences in physical training and fitness were shown between the groups. Never users averaged the most total physical training, followed by ENDS users, smokers, and then dual users. Compared with never users on the fitness tests, ENDS users had an adjusted mean difference of +27 seconds on the 2-mile run, −4.56 push-ups, and −2.01 sit-ups; smokers averaged +8 seconds, −2.15 push-ups, and −1.44 sit-ups; and dual users averaged +32 seconds, −5.17 push-ups, and −3.88 sit-ups. Dual users had significantly (p<0.05) lower scores than current smokers and never users on all 3 fitness events.
This study suggests that individuals who use e-cigarettes and tobacco cigarettes average a lower level of fitness than individuals who abstain.
Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers’ injuries occur gradually from cumulative micro-traumatic damage to the ...musculoskeletal system as a result of physical training activities. Paradoxically, the very physical training activities required to improve soldier performance also result in injury. Determining the amounts and types of physical training that maximize performance while minimizing injuries requires scientific evidence. This evidence must be incorporated into a framework that ensures scientific gaps are addressed and prevention efforts are evaluated. The five-step public health approach has proven to be an effective construct for Army public health to organize and build an injury prevention program. Steps include: 1) surveillance to define the magnitude of the problem, 2) research and field investigations to identify causes and risk factors, 3) intervention trials and systematic reviews to determine what works to address leading risk factors, 4) program and policy implementation to execute prevention, and 5) program evaluation to assess effectiveness. Dissemination is also needed to ensure availability of scientific lessons learned. Although the steps may not be conducted in order, the capability to perform each step is necessary to sustain a successful program and make progress toward injury control and prevention. As with many U.S. public health successes (e.g., seatbelts, smoking cessation), the full process can take decades. As described in this paper, the U.S. Army uses the public health approach to assure that, as the science evolves, it is translated into effective prevention.
Background:
Numerous studies document the health benefits of a physically active lifestyle, but relatively few document the hazards of physical activity. Because of the requirement for physical ...fitness to complete their mission, the United States military services have a vested interest in understanding the benefits and risks of physical activity including exercise and sports. One of these risks is injury. Rates and proportion of injuries caused by exercise- and sports-related (ESR) activities have not been reported previously across the services.
Purpose:
The purposes of this population survey were to (1) document the rates and proportion of all injuries caused by ESR activities among military personnel, (2) compare rates across the military services, and (3) describe the causes and types of ESR injuries as well as associated days of limited activity.
Study Design:
Descriptive epidemiology study.
Methods:
The Defense Manpower Data Center administered the web-based 2008 Status of Forces Survey of Active Duty Service Members to a random sample of active-duty personnel. In all, 10,692 servicemembers completed the survey, which included questions about injuries from any cause and from exercise and sports during the previous year. Responses were weighted to produce population estimates for injury rates (any injury and ESR injury). Percentage distributions were used to describe activities, injury types, days of limited activity, and contributing factors for ESR injuries.
Results:
There were 49% of servicemembers who sustained an injury from any cause in the previous year; 25% had an ESR injury. Thus, 52% of all injuries were ESR injuries. ESR injury rates ranged from 20% for the Navy to 33% for the Marine Corps. Running accounted for 45% of ESR injuries. Forty percent of ESR injuries were sprains and strains. As an indicator of injury severity, 35% of ESR injuries required more than 2 weeks of limited activity.
Conclusion:
This study quantified the overall incidence of injuries and the large proportion that are caused by exercise and sports among military personnel, a population of healthy, physically active adults. Prevention strategies should focus on running, weight training, basketball, and football. Recommendations include adherence to evidence-based practices to reduce the occurrence of ESR injuries.
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